GREENE 
BROTHERS' 

COURSE  IN 

PLATE-WORK 

IN  THREE  LECTURES 


'\  .  » 


CT  THi   ^ 
O  LIBRARIES  S 

HEALTH 
SCIENCES 
LIBRARY 


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in  2010  witii  funding  from 
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Peter  Thomas  Greene 
(  1828—1909  ) 


Jacob  Wesley  Greene 
(  1839  ) 


Gratitude  in  inemoriam 


To  the  memory  of  our  elder  l)r()ther  and  pre- 
ceptor, the  late 

Peter  tbomas  Greene 

of   New   Albany.    Indiana,   this    little    work   i^ 
gratefully  dedicated. 


Dr.  P.  T.  first  recognized  the  practical  ad- 
vantage of  the  shallow-tray  non-tissue-strain- 
ing principle  in  impression-taking,  and  was  the 
first  to  introduce  it. 

He  was  an  ardent  worker  in  the  early  evolu- 
tion of  what  since  has  been  developed  into  the 
present  established  Greene  Brothers'  Advance- 
Test  System  of  Plate-work. 

To  his  helpful,  courageous  persistency,  in 
the  face  of  ignorance,  suspicion,  jealousy,  and 
envy  (difficulties  especially  attending  old- 
fashioned  secret  teaching),  the  new  System 
owes  its  founding ;  and  progressive  plate- 
workers  owe,  and  will  duly  bestow,  their  sin- 
cere gratitude. 

Our  brother  began  life  near  Corydon,  Harri- 
son County,  Indiana,  in  IS'?8,  and  departed 
from  his  earthly  home  in  New  .Vlbany,  to  the 
many  loved  ones  of  his  youth  and  later  years, 
('//  the  other  side,  in  February,  1900. 

He  served  industriously  in  his  calling,  as  a 
progressive  worker  and  instructor.  o\er  half  a 
century. 

jACoi;  \\'.  GrilEXK. 

ChiV.ieothe.  Mo..  July  i,  JQio. 


REVISED  EDITION,  1914 


GREENE  BROTHERS' 

CLINICAL  COURSE 


IN 


DENTAL  PROSTHESIS 

IN  THREE  PRINTED  LECTURES 


NEW  AND  ADVANCE-TEST  METHODS 

In  Impression,  Articulation,  Occlusion 

Roofless  Dentures,  Refits  and  Renewals 

BY 

JACOB  W.  GREENE 

Chillicothe,   Mo. 

Author   of    "Dental    Information    for    the    psople"  — 1870.    $1.00 

Patentee  of  Greene's  Ready-Made  Metal  Models — 1908 

Inventor  of  Greene's  Removable- Handle  Impression   and   Bite  Tray      1910 

Inventor  of  Weighted    Lower    Bite-Plate;    Tongue  Rest    Flanges   ("Jokers") 

for  Lower  Dentures;  Real  Anatomical  Bites  for  difficult  Cases; 

Greene's  Pressometer,   for  Measuring  Stress,  in  Bites:  Short- 

Cut  and  Quick-Step  Methods  in  Plate-Work,  and  Greene's 

Occlusion   Retainer  to  Do  Away  With  All  After-Grinding  and 

Greene's  Metal  Roof  Reinforcer  to  Prevent  Elxtra  Thickness  of  Plates. 


Copyright.    1910 

By  Jacob  W.  Greene 

Chillicothe,  Mo. 


Copyright.  1914 

By  Detroit  Dental   Manufacturing  Co. 

Detroit,   Mich. 


PUBLISHED  BY 

DETROIT  DENTAL  MANUFACTURING  CO. 

DETROIT,  MICHIGAN 


CONTENTS 


LECTURE  I. 

Upper  Mouth  Only. — Reasons  for  Improved  Methods. 
- — Old  Ways  Unreliable. — Test  Impressions. — Impressions 
of  All  Sorts  of  Mouths. — All  Kinds  of  Impression  Mate- 
rials— Plaster,  Modeling  Composition,  Bee's-Wax,  and 
Combinations  of  Them. — All  About  Roofless  Plates,  Re- 
fits, and  Renewals  from  Old  Plates,  by  the  Greene  Test 
Methods. — Short-cut  and  Quick-step  Upper  Plates. — Un- 
reliability of  Plaster  Models  and  How  The\'  Cause  Fail- 
ures.— Instructions  in  Use  of  the  Greene  Xon-changeable, 
Ready-made  ]\Ietal  ^lodels  in  ^"ulcalli/,intl;  and  Swaging. 
— And  so  forth. 

LECTURE  II. 

Lower  Mouth  Only. — Principles  and  Methods  of  First 
Lecture,  as  Applied  to  Lower  Cases ;  with  Others  Special 
to  the  Lower. — Partial  Impressions  with  Leaning  Teeth 
and  Bell-shaped  Crowns. — Why  Lower  Dentures  Are  So 
Generally  Unsatisfactory  and  How  to  Correct  the  Diffi- 
culties; by  Muscle-trimming.  Conforming,  Shot-weighting 
and  Tongue-})ower  Methods,  and  Consequent  Suction. — 
And  so  on. 

LECTURE   III. 

The  Bite,  and  All  that  follows,  to  the  Finished  Case. 
— Only  the  Tired-rest  Position  of  the  Jaws  Reliable. — 
The  "Xo-bite"  Gives  this  Position. — How  to  Take  It  and 
Test  It. — Bite  ]Must  Give  Four  Essential  Points. — (a)  The 
Show-length  of  the  Teeth;  (/->)  Their  In-and-Out  Stand- 
ing; (f)  Their  Occlusion;  and  (r/)  The  Strain  on  the  Tis- 
sues.— A  Simple  Pressometer. — Bites  for  Lower  Partials 
and  All  About  Them. — Some  Old  Troublesome  Problems 
Solved. — Brand-new  Occlusion  Scheme  for  Difficult,  "Crip- 
pled" Cases. — Each  ^loutli  Its  Own  Automatic  Articulator 
in  the  Finis.  —  Ethics  in  Plate-work.  —  Interesting  and 
Instructive  Lecture  to  Patient  Before  Dismissal — And 
much  more. 


IX   Dextal   Prosthesis.  vil 

CAPTIONS  AND  SUB-HEADINGS 

Ix»ir.\Tix(;  Thk.mes  and  Methods 


LECTURE  NUMBER  ONE 


Ui'i'EFt  Dentures. 

I'AGE 

Printed  Notes  for  Students'  Riferenee f) 

Class  Close  Around  the  Table 11 

First  Hour  of  First  Three-Hour  Lesson 1"2 

\^'hat  W'v  ^^'ant  to  Do  in  Taking;  an  Imjiression U! 

All  Moviiig  Tissues  Must  Move  Air-Tight Hi 

An  Appro.xiniate  Correctable  Ini])ression Hi 

Fit  Tray  to  .Mouth 17 

Two  Ways  of  F'itting  Tray IS 

The   Fitted   Metal  Tray ]<) 

Upper  Trays  Illustrated — Old  and  New -21 

How  to  Take  Correctable  Impression ■2'2 

Two  Ways  to  Take  Correctable  Impression -22 

Student's  Correctable  Impression 22 

Practitioner's  Apjjroximate  Inii)ression   ( I'irst  Ste))).  .  .  23 

Practitioner's  Test  for  Fit 2') 

Suppose  It  Doesn't  Center-Test 26 

Trim  It  Approximately   (Seccnid  Steji) 26 

To   Get  Length  of  Plate  in  a  Soft  Mouth -28 

To   Find  Length  of  Plate  Over  a  Hard  Palate 29 

Correct  Roof  to  Test-Fit  (Third  Step) :5() 

Correct  the  Rim  to  Muscles  (F'ourth  Stej)) 32 

Relief-JVitJiniit-Lrdh-,   the    Modtling-Compouiul    Impres- 
sion  Pass-Word    32 

^'erv-Edging.  or  .Muscle-Trimming 33 

To  Especially  Fit  Particular  Muscles 34 

Conform  Com))ouiul  to  Soft  Part  (  Fifth  .Step) 36 


VIII  Greene  Brothers'  Clinical  Course 

PAGE 

Conform    ("Post-Dam")    Back   Palate    (Sixth   Step)...  39 

The  Essential  Art  in  Handling  Modeling  Compound.  .  .  41 

Uniting  Details    4-2 

Test  tlie  Completed  Impression 43 

Stop,  Think  and  Reason 43 

If  Impression  "Swallows   Down" 44 

About   Nausea    4o 

Make  Model  on  Tested  Impression 45 

Modeling-Compound   Impressions.   Old   and    New    Way 

Illustrated,  Figures  4  and  5 4(i 

How  to  Make  the  Model 48 

To  Separate  Model  from  Impression 49 

Don't  Let  Impression  Change 49 

Metal  vs.  Plaster  Models oO 

Greene's  Non-Changeable  IModel  S\'stem 51 

Modeling-Compound  Impressions  in  Difficult  Cases ....  53 

Soft,  Flabby  Alveolar  Ridge  with  Hard  Roof 54 

Vienna  Paste  for  Reducing  Soft  Gums 55 

Flabby  Gums  in  Front  and  Hard  on  Sides 57 

A  Valuable  Review 58 

Roofless  Denture 59 

Instructions  to  Patients 6l 

Extra  Supports  to  Roofless  Plates 6l 

Retention  of  Roofless  Plates .  62 

Partial  Upper  Impressions 62 

I>eaning  Teetli  and  Bell-Shajn-d  Crowns 63 

Recapitulation  on  Coring 64 

Plaster  Impressions  for  Partial  Plates 6  !• 

To  Test  a  Plaster  Impression 67 

Plaster  Impressions  in  ^Modeling-Compound  Trays 68 

To  Take  Test-Impressions  in  Plaster 69 

Pass-Word  for  the  Greene  ]\Iethod  of  Plaster  Impres- 
sions      71 

"\^'hy  Plaster  at  All"  for  Impressions 73 

A  Quick-Step  Denture  Method 74 

Typical    Upper   Impression    in    Plaster — Old   and    New 

Way  Illustrated,  Figures  7  and  8 75 


IX  Dental  Prosthesis.  ix 

PAGE 

Refitting  of  Plates 77 

Temporary    Refits    with    "Perfection"    Comjjoiind    Wa- 
ters  .  . ". 78 

Permanent  Refit  with  Vulcanite 79 

To    Refit    with    Plaster    Impression    by    the    Pass-Word 

Method 82 

Common  Old-Fashioned  Refit  of  Rubber  Plates 83 

To  Reproduce  New  Plates  from  Old  Ones 83 

The  Greene  Ready-Made  Models  in  Refits 80 

Precaution  in  Refitting;  and  Renewing;  Plates 86 


Greene  Brothers'  Clinical  Course 

CAPTIONS  AND  SUB-HEADINGS 

Jndh  .\Tix(;  Themes  and  Methods. 

LECTURE  NUMBER  TWO 


Lower  Dentures 

PAGE 

First:  A  Modeling-Compound  Impression  in  Detail...    87 

To  Avoid  Straining  the  ^Muscles [}\ 

Typical  Lower  Trays^  Old  and  Xew.  Figures.  10.  11.  12   9'' 

Take  a  Correctable  Lnpression J)! 

Practitioner's  Correctable  Lnjiression — Step  No.   1  .  .  .  .    [)() 

Step  Xo.  ^  in  Lower  Lnpression 101 

Step  Xo.  :i  in  Lower  Impression 101 

Step  XO.    1  in  Lower  Impression 103 

Step   Xo.   ,")  in  Lower  Impression lOt 

Step  Xo.  6  in  Lower  Impression lOo 

Step  X'o.  7  in  Lower  Impression 106 

Step  Xo.  8  in  I>ower  Impression 108 

Step  Xo.  9  in  Lower  Impression 109 

Step  Xo.  10  in  Lower  Impression 110 

A  Lower  Plaster  Impression Ill 

Partial  Lower  Impression 1  l.S 

^Modeling-Compound    Impression    with    Leaning    Teeth 

and  Bell-Shaped  Crowns    Ill 

Coring-Out  for  Under-Cut  Im])ressions .,115 

Old-Time  Inijirovemeiits  in  All-  Plaster  Lower  Impres- 
sions     117 

Old  Way  and  Xew  Way  Modeling-Compound   Im^Jres- 
sions  illustrated,  Figures  13,  14  and  15 l'-21 

To  Refit  a  Vulcanite  Lower  Plate  Temporarily 122 

To  Refit  a  \'ulcanite  Plate  Permanentlv 123 


IN   Dental   Prosthesis.  XI 

PAGE 

Renewal  of  Rubber  Plates  from  Old  Ones 126 

Weight  in  Lower  Dentures 128 

To  Shot- Weight  an  Old  Vulcanite  Plate 129 

To  Shot- Weight  a  Xew  Vulcanite  Plate 129 

To  Strengthen  Lower  Plate 130 

Mixed  Lower  Plates 131 

Swaging  Lower  Plates 132 

Cast  Aluminum  Plates 133 

Refitting  Lower  Metal  Plates  with  Vulcanite 133 

Substitution   of   Heavy    Cast   Plates    in    Place   of   \'ul- 

canite  or   Celluloid 134 

To  Refit  and  Renew  a  Cast  Plate  with  the  Same  Mate- 
rial      135 


XU  Greexe  Brothers'  Clinical  Course 

CAPTIONS  AND  SUB-HEADINGS 

IxDicATixG  Themes  axd  Methods. 


LECTURE  NUMBER  THREE 


PAGE 

Articulation.  Occlusion.  Bite.  etc..  etc 136' 

Now  for  the  "Bite" 141 

Absurdity  of  a  Common  Motionary  Bite 14^ 

Tired  Relaxation  the  Natural  Position  of  the  Jaw US 

What  Do  We  Expect  from  a  Bite.^ lil 

The  "Biscuit."  or  "Mush,"  or  "Squash"  Bite 145 

The  Rim  Bite 145 

The  Greene  Improved  and  Perfected  Rim  Bite 146 

Bite  for  a  Full  Upper-and-Lower  Set 146 

Ujjper  ^Nlodel  First 147 

Trim  for  Fullness  of  Upper  Lip  and  Teeth 147 

Trim  Bite-Plate  for  Length  of  Lpper  Teeth 148 

Heavy   Lower   Bite-Plates 149 

Trim  Lower  Bite-Rim  for  Length  of  Lower  Teeth 149 

The  Outstanding  of  the  Lower  Teeth 150 

The  Tired-Rest  Test-Bite,  or  "No-Bite" 151 

Re-inspect  No-Bite  for  Feature  Test 153 

Greene  Tired-Rest   Bite    ("No-Bite")    Illustrated.   Fig- 
ure 16 153 

Fourth  Point,  or  Pressure  Feature,  in  a  Bite 154 

A  Simple,  Practical  Pressometer 154 

How  to  Use  the  Greene  Pressometer  in  a  Strain  Test.  .  155 

Unequal  Pressure  Sometimes  Needed  in  a  Bite 157 

Verifying  the  No-Bite 158 

Matliematical  Test  of  the  No-Bite 158 

The  Third  Still-Jaw  Test l6() 


IN   Dental   Prosthesis.  xill 

PAGE 

Greene  Pressometer  Illustrated.  Figure  17 16() 

Transfer  Xo-Bite  to  the  Articulator l6l 

Anatomical  Movement  on  the  Xo-Bite l6l 

A  "Crijjple"  Mouth  Its  Own  Articulator  in  tlie  Fi)ii.s.  .  .  l6'2 

Correct  Bites  Till  They  Do  Test l64 

Firm  Articulator  Important iG.'j 

Articulator  in  Most  Common  Use l66 

To  Fix  Lower  Model  on  Articulator idS 

Base-Plates     l69 

The  Base-Plate    170 

Setting  Up  Teeth  on  Base-Plate 171 

Trying  Teeth  in  the  Mouth 173 

Importance  of  Stress    17^ 

Side  Remarks— Prosthetic  Quackery 175 

Weighted  Modeling-Compound  Bite-Rim 177 

Still  :More  About  the  "Joker" 179 

Another  Reason  for  the  Joker 179 

The  Joker  a  Xew  Idea 1 80 

The  Lateral,  or  "Sheep-Bite."  Movement 181 

The  Common  Old  Plain-Line  Articulator  Inij^roved  for 

Anatomic  Work    183 

The   Forward   Bite   Mivement 185 

Each    Mouth    Its    Own    Articulator    in    the    Finis    Fur- 
ther Described 185 

Class    Requests     Difficult    "Cripple"-Case    ArticuLation 

Again  and  Further  Explained 186 

Xew  Way   to   Take   Test   X'o-Bite.   in    Xo-Handle   Bite- 
Trays    189 

Improvement  in  Biscuit  Bites 190 

Flasking  the  Case 191 

Packing  and  Vulcanizing 192 

How  to  Vulcanize 193 

Dishonesty  in  Rubl)er  Plates I94 

Last  Finishing  Care  in  Articulation I96 

A  Still  Finer  Last  Grinding  Touch 197 

Better  Defer  Final  Adjustment 198 

Instructions  to  Wearer  of  Artificial  Teeth 198 


XIV  Greene  Brothers'  Clinical  Course 

PAGE 

No-Bite  of  a  Plain  Upper  Case 201 

The    Non-Lateral,    Minimum    Short-Bite,    or    No-Bite, 

Described  Again,  by  Request 203 

The  Full  Upper  No-Bite  Test 201 

Transfer  the  No-Bite  to  Articulator 205 

Pink  Rubber  and  Gum  Sections 207 

Bites  in  Scattering  Cases 207 

Pressometer  in  Upper  Cases 208 

Partial  Posterior  Lower  Bite 208 

The  New  Common  Sense  Occlusion 213 

Every  Mouth  Its  Own  Articulator 213 

Occlusion  Retainers  Illustrated 21(1 

Greene's  Occlusion  Retainers 217 

Full  Double  Set 218 

Common  Sense  Occlusion  Shown  in  Mouth 219 


IX   Dental  Prosthesis.  xv 


INDEX 


PAGE 

Upper  Trays  Illustrated — Old  and  New  Figures  1,  2.  3.  29 

Muscle-Trimming,  or  Very  Edging 3'! 

\  ery-Edging.  or  Muscle-Trimming 33 

Length  of  Upper  Plate 28.   29.  30 

Post-Damming   Rear   of   Plate 39 

Practitioner's  Method  of  Fitting  Tray  to  Mouth.  17.    18.  19 

Conforming    3().  37.  38 

"Pass-^^'ord"   Method   of   Plaster    Impression ..  .6'9.   7<).  71 

Test  for  Pass-Word  Imj^ression 71 

Fit  Tray  to  Upper  Mouth 17.   18.  19 

Fit  Tray  to  Lower  Mouth 91 .  92 

Lower    Trays     Illustrated — Old    Style    and     Impro\fd. 
Figures  10,  1 1 ,  1 2 93 

Correctable    Lower    Modeling-Compound    Impression — 

Student's  Method   [H 

To  Separate  Impressions  from  Approximate  Model.  .  .  .  9-' 

Coring  Out  Under-Cuts  in  Lower  Impressions 9-5 

Practitioner's  Correctable  Lower  Impression 9G 

Remove  Teeth  from  Old  Plate 8  t 

Cloth  in  Packing 193 

Refitting  Plates  with  Vulcanite 79 

Mtreuri;il-Tin   Paste  for  Reuio\ing  Tin-Foil   from  \'ul- 
canite    Plates    82 

A  Quick-Step   Denture 71 

Greene's  Quick-Step  Denture 7i,  7.).  7() 

Tracing-on    Modeling    Com])ound    witli    Kerr    Tracing- 
Sticks  17 

Greene's  Occlusion   Hrtaiiurs   Illustrated 2l6 


GREENE  BROTHERS'     CLINIC     LECTURE 
COURSE  IN  PLATE- WORK. 

WHY  IN  PRINT. 

While  this  Course  is  hmited  to  plate-work, 
it  embraces  most  of  the  important  points  in 
that  specialty;  and  on  lines  of  original,  new 
and  improved  methods.  Also  it  is  more  par- 
ticularly meant  for  vulcanite  and  similar  work; 
of  wliich  probably  90  per  cent,  of  all  plates  are 
now  made. 

It  is  given  as  a  private  course  of  instruc- 
tion for  practical  utility,  and  more  especially 
for  active  practitioners. 

Xo  "Jionors"  are  offered,  save  that  for  im- 
provcmeni  in  this  most  difficult  and  vmcertain 
branch  of  dentistry. 

Yet  in  self-defense,  against  deception  and 
fraudulent  pretensions,  we  give  our  certificate 
to  show  one  lias  taken  our  Course  directly  from 
central  authority. 

Tliougii  we  liave  been  instructing  more  or 
less  from  the  incipiency  of  the  work  fifteen 
years  ago,  when  we  gave  but  an  hour  (then 
mostly  on  impressions),  up  through  its  devel- 
o])ment  to  an  eight  to  ten-hour  Course,  we  have 
not  been  giving  it  publicity  till  1907. 

So  there  are  yet  but  a  few  schools  that  have 
it  familiar  enough  to  enable  its  thorough  teach- 
ing to  inexperienced  students.  From  now  on 
we  expect  to  give  it  to  all  willing  to  pay  rea- 
sonably for  our  services. 

As  justification  for  charging  for  our  time,  it 
is  necessary  only  to  mention  that  we  have  en- 
tirely  given   up   our   ])rivate   ])ractice   to   devote 


2  Greexe  Brothers'  Clinical  Course 

our  aged  efforts  to  the  new  Private  Instruction 
Business  for  a  livelihood. 

About  teaching  it:  After  many  years'  exper- 
imentation and  gradual  development,  our  prac- 
tical Course  now  embraces  a  System,  including 
some  advance  test  methods,  where  the  work  is 
exact  and  technical.  Hence,  the  imparting  of 
it  to  others  is  not  a  little  matter  to  be  "told" 
on  the  sidc'walk;  nor  even  well  taught  at  a 
distance,  in  hurried,  public  clinics,  by  an  inexperi- 
enced novice. 

To  our  amusement,  dentists  sometimes  tell 
us  they  "already  know"  our  methods  because 
someone  has  "told"  them  what  they  are.  The 
fact  is:  to  perfectly  teach  the  Greene  System 
(or  any  other)  one  must  fully  understand  its 
basic  principles,  have  expert  experience,  and  be 
familiar  with  practical  teaching  requirements. 

To  this  end  our  business  plan  has  been  to 
instruct  individuals,  classes,  and  local  societies, 
in  limited  numbers,  in  their  towns  and  cities; 
usually  by  pre-arrangement. 

When  wanted,  we  go  also  to  colleges  and 
instruct  classes  of  advanced  students,  in  groups 
of  ten  or  less. 

At  no  distant  time  we  hope  to  see  many  of 
the  plate-work  instructors  in  the  schools  familiar 
enough  to  themselves  fully  teach  their  students 
in  the  new  ways.  The  trouble  is  that  so  many 
schools  employ  inexperienced  men  and  boy  in- 
structors on  glory'pay  in  this  important  branch 
of  dentistry. 

The  need  of  our  Course  is  fully  emphasied 
M'hen  eminent  prosthesists  publicly  assert  that 
"Good,  artistic  plate* work  is  fast  becoming  a  lost 
art." 

Years  ago,  even  up  into  the  '80s,  a  goodly 
share  of  most  dentists'  practice  consisted  of  plate* 


IX  Dental   Prosthesis.  3 

Avork.  There  was  so  much  of  it  done,  and  so  com- 
paratively few  dentists  to  do  it,  that  many  be- 
came experts,  even  in  the  old  guess-work 
methods. 

So  the  average  grade  of  the  out^put  was  de- 
cidently  above  that  of  now'a«times;  now,  when 
most  of  the  old  "mechanical  dentists'  are  gone, 
and  the  voung  men  disdain  the  "dirtv,  uncertain 
work." 

And  so  it  is  that  the  once  attractive,  artistic 
specialty  has  been  discarded  by  both  the  boys 
and  the  "best  men"  and  turned  over  to  commer- 
cial (mal)])ractice.  And  such  practice  obtains 
to  the  extent  that  half  the  plate=wearers  look 
hke  silly  and  vicious  ghosts  grinning  through 
moonshine. 

It  was  the  prideful  effort  of  the  old-timers  to 
rather  hide  art  and  imitate  Nature.  So,  in  the 
more  professional  (we  called  it  "mechanical") 
past,  dentists  far  more  seldom  allowed  patients  to 
dictate,  and  "j)ick  out  teeth  to  suit  themselves"; 
which  they  are  wont  to  do  ^\ith  unquestioned 
commercial  license. 

Sure  enough  the  old=timers  have  reason  to 
conclude  that  "artistic  plate-work  is  fast  becom- 
ing a  lost  art."  3Iuch  of  it  is  being  aone  in 
"false=tooth  factories"  by  boys  who  have  never 
studied  dentistry  at  all,  and  who  never  get  to  see 
the  disfigured  faces  through  which  their  glossy- 
white  pearls  must  grin  -  shine  so  hideously. 

How  many  dentists  (commercial  pro])rietors) 
boastfully  tell  us:  "Z  don't  do  platenvork  my- 
self. /  simply  take  the  impressions  and  bites 
and  have  the  main  work  done."  What  a  pro- 
fessio rial  co n  ce])tlon ! 

Two  gobs  of  material — im])ression  and  bite — 
hurriedly  thrust  into  the  moutli  and  jerked  out; 
then  turned  over  to  the  laboratory  boys  and  girls, 
strangers  in  the  case — "sight  miseen"! 


4  Greene   Brothers'  Clinical  Course 

The  "toosbusj^"  dentist  (and  there  are  many 
of  them),  who  can  neither  do  his  own  plate' 
work  x^ersonally  nor  have  it  done  under  his  own 
supervision,  giving  due  study  to  each  case  on 
its  own  pecuhar  merits,  should  turn  it  over  to 
the  legit unate  specialist,  who  can  handle  such 
important  practice  consistently  and  properly. 

It  is  one  of  the  purposes  of  the  Greene 
Brothers'  Course  to  encourage  and  train  special- 
ists to  care  for  this  most  difficult  work  of  the 
dental  art=science. 

For  years  we  have  been  urged  to  give  our 
lecture « demonstrations  in  printed  form,  and 
teach  our  methods  in  that  more  convenient  and 
less  expensive  way.  But  for  several  reasons  we 
have  refrained  from  doing  so  till  now. 

We  have  feared  the  difficulty  of  teaching  fine 
f)oints  in  art  by  mail.  AVe  feared  failures  might 
bring  our  System  into  disrepute  before  fully 
established,  and  ruin  at  least  our  business. 

But  now  we  feel  differently.  After  a  mid* 
teen  years  of  persistent  work,  and  since  we  have 
reached  national  attention  by  publicly  lectur- 
ing and  demonstrating  to  local  and  State  and 
Xational  meetings,  with  fully  satisfactory  re- 
ception, we  are  persuaded  to  yield. 

Since  we  have  the  backing  of  thousands  of 
testimonials  of  satisfaction  and  earnest  recom- 
mendations from  our  student  ])ractitioners  of  all 
classes  and  grades  in  half  of  the  States  in  the 
Union,  we  no  longer  fear  that  a  few  possible 
failures  to  understand,  or  a  few^  technical  criti- 
cisms, or  even  kickers,  would  seriously  harm  our 
"traveling  dental  school." 

Then,  as  there  is  but  one  of  us  left  and  as 
he  is  doing  business  on  borrowed  time  (this 
1910),  we  have  consented  to  this  publication. 

In  so  doing  we  have  first  in  mind  those  who 
have  taken,  or  may  take,  our  Course  from  us 


IX  Dental  Prosthesis.  5 

in  our  regular  way,  but  who  may  not  have 
caught  onto,  or  may  not  catch  onto,  all  of  our 
numerous  new  pointers;  also  those  who  may 
have  forgotten,  or  may  forget,  some  of  them 
before  opportunity  for  practice. 

To  such  the  printed  Course  can't  fail  to  prove 
a  most  valuable  reference;  even  though  in  it  we 
have  abridged  many  of  our  verbal  repetitions  and 
cut  out  some  of  our  odd  but  convincing  illustra- 
tions, used  in  the  lectureswork. 

Second,  we  have  in  mind  the  thousands  who 
will  have  their  attention  called  to  our  work,  but 
could  never  get  it  from  the  central  source  in  any 
other  way  than  this. 

I  might  add  that,  though  a  student  of  our 
methods  through  these  printed  lectures  will  un- 
fortunately miss  the  inspiration  of  personality 
that  always  goes  with  all  verbal  teaching  (and 
to  M'hich,  maybe,  too  much  is  sometimes  accred- 
ited in  our  class^talks) ,  he  will  nevertheless  get 
our  most  important  inventions,  discoveries  and 
new  practical  pointers,  if  he  will  think. 

We  have  tried  to  be  clear  and  comprehensive, 
and  hence,  in  some  sense,  to  some  readers,  may  be 
uselessly  detailing. 

To  steer  clear  of  literary  pretense,  when  I 
know  I  'm  not  "in  it,"  I  have  herein  held  much 
to  the  colloquial  and  self^idiomatic  of  my  verhcd 
Course. 

Having  scratched  all  this  out  from  steno- 
graphic notes,  taken  from  my  offhand  talks  in 
class'Work,  I  may  have  edited  carelessly,  if  not 
ignorantly,  as  to  elegance  of  diction.  With  my 
sole  aim  to  eliminate  some  of  the  guess-work  and 
uncertainty  from  "mechanical  dentistry"  and  to 
help  restore  the  "lost  art,"  I  may  have  thought 
(maybe  known)  less  of  rhetoric  than  of  work. 

Maybe  I  should  apologize  for  even  A\'orse — 
for   coining     some   non^dictionarial   vocabulary. 


6  Greene  Brothers'  Clinical  Course 

Well,  that's  been  done  before;  otherwise  we  'd 
have  no  "occlusion,"  nor  "articulation,"  applica- 
ble to  artificial  teeth.  Pardon  my  independence. 
If,  with  all  my  acknowledged  shortcomings, 
I  have  been  helpful,  in  a  measure,  to  the  work- 
ing dentists  and  to  the  wearers  of  artificial  teeth, 
my  purpose  has  been  attained  and  my  chronic 
ambition  gratified. 

Jacob  W.  Greene. 

CRITICS,  DON'T! 

''Ohj  that  mine  enemy  would  write  a  hook!" 

DoN^T  imagine  tliis  a  text^book,  please.  It  's 
merely  a  series  of  offhand,  "show=me"  talks  in 
j)rint;  by  an  old'and=childish  "tooth^dentist" — 
three'scoresand^ten,  ten  more,  and  then  some. 

Dox^T  tantalize  while  I  weep  for  its  literary 
Aveakness!  It  was:  Write  this,  or  keep  on  talk- 
ing— three  to  six  hours  a  day.    I  'm  tired. 

DoN^T  criticise  my  repetition.  I  've  learned 
that  most  dentists  need  the  like  in  their  studies. 

DoN^T  object  to  this  mail  Course.  My  "itin- 
erant dental  school"  is  getting  too  old  to  trek. 

DoN^T  wink-smile  at  my  impromptu  vocab- 
ulary. It  's  the  answer  to  my  prayer  for  inspira- 
tion, meet  for  the  occasion. 

DoN^T  accuse  me  of  competition  with  (otlier) 
dental  colleges.  I  'm  only  setting  up  and  finish- 
ing their  goods,  shipped  out  in  the  knock-down. 

DoN^T  blame  me  for  not  having  my  sub- 
themes  and  pointers  in  more  systematic  order. 
I  was  incarnated  in  Old  Hoosier,  in  the  early 
days,  in  the  woods,  among  the  whoo-owls,  on 
Friday  night,  in  the  dark  of  the  moon,  out  of 
order,  against  my  better  judgment. 

DoN^T  accuse  me  of  egotism.  I  'm  unassum- 
ing.    I  'm  patient.     I  can  listen  by  the  hour  to 


IX   Dental   Prosthesis. 


dentists  repeating  how  they  do  things    (by  the 
old  guess=ways) . 

Dox^T^  above  all,  criticise  because  you  can't 
understand  me.  "The  carnal  ( dento  *  carnal ) 
mind  cannot  discern  spiritual  (dento-spiritual) 
things." 

J.  W.  G. 

INTRODUCTORY. 

While  the  Greene  Brothers'  Prosthetic 
Course  is  limited  to  plate'work,  it  takes  in  about 
all  of  that  much=neglected  brancli;  and  along 
new  lines  and  advance  test  methods. 

By  test  methods  we  mean  such  as  enable  us 
to  know  by  actual  test  in  advance  what  the  re- 
sultant outcome  will  be. 

To  illustrate  my  meaning  I  will  suppose  you 
have,  for  instance,  a  plate  that  exactly  suits  you 
and  its  wearer.  If  you  should  mold  and  du])li- 
cate  another  one  from  it,  you  would  know,  in  ad- 
vance, just  how  the  new  one  would  be.  Bear  in 
mind,  I  say,  if  you  duplicate  the  tested  plate. 

Xow,  it  is  proposed  to  give  you  a  whole 
course,  amounting  to  a  System,  of  advance=test 
plate^work  methods,  covering  about  all  of  tlie 
imjoortant  ])oints  in  the  specialty. 

THREE  SEPARATE  LECTURES. 

The  Course  is  generally  given  in  three  sep- 
arate clinic  lecture*demonstrations,  wherein  the 
principles  are  taught  by  reason  and  analogy,  and 
the  ap])lication  by  "showing"    (from  Missouri). 

Incidentally  it  becomes  necessary  to  sliow, 
likewise  by  reason  and  ajDplication,  that  some, 
and  not  a  few,  of  the  old  and  commonly  used 
methods  are  not  only  defective  and  faulty,  but 
absolutely  erroneous  and  absurd. 


8  Grekxe   Brothers'  Clinical  Course 

Sometimes  it  becomes  necessary  to  show  the 
defection  of  an  old  road  bridge,  and  to  remove 
it  before  substitutino-  a  better  one  in  its  ])lace. 
And  again  sometimes  it  's  best  to  remove  the 
old  structure  by  section  and  piece  and  substitute 
corresponding  parts  of  the  new  one,  working  the 
old  and  new  in  together,  into  one  reconstruction. 

OUR  SYSTEM  A  GENERAL  RECONSTRUCTION. 

In  a  comprehensive  sense  the  Greene  Broth- 
ers' System  is  a  reconstruction  of  plate=work 
methods. 

If  in  plate^work  the  impressions  and  models 
and  "bites"  and  the  like  can  be  compared  to  the 
abutments  and  pillars  and  arches  of  a  railroad 
bridge,  our  method  may  be  taken  as  a  somewhat 
radical  departure  reconstruction. 

I  hope  to  make  these  truths  appear  plain  as 
I  proceed  systematically  in  my  analogies  and 
jDractical  demonstrations. 

THE  FIRST  SECTION,  OR  "DEGREE." 

The  first  one  of  the  three  sections  of  our 
Course,  here  to  be  considered,  pertains  to  the 
upper  mouth  onJif.  And  here  I  '11  mention,  as 
an  indicating  prelude,  the  leading  subjects  to  be 
dealt  with  in  this  lesson;  the  minor  ones  to  come 
in  at  opportune  times  and  places,  as  we  proceed. 

First — Test  Impbessiox;  full  and  partial;  in 
all  types  of  cases,  easy  and  difficult  ones ;  with  all 
the  different  sorts  of  materials  in  common  use,  as 
modeling  composition,  plaster,  bee's-wax,  and 
combinations  of  them. 

Second — The  whole  matter  of  roofless  dent- 
ures, in  clear  mouths  and  also  over  "anchors" 
(worn^off  teeth)  ;  and  partial  cases. 

Third — Test=methods  of  refitting  plates,  both 
temporarily  or  permanently;  and  renewing,  or 


IN   Dextal  Prosthesis.  9 

duplicating,  new  ones  from  old  ones,  still  main- 
taining occlusion  and  position  of  teeth,  or  chang- 
ing the  same  if  desired. 

Fourth — The  making  of  dentures  by  short- 
cut, quick  methods,  whereby  a  fast  worker  can 
make  a  perfectly  fitting  {pre-tested)  plate  of 
vulcanite  or  celluloid  in  from  twosand-ashalf  to 
three  hours,  from  start  to  finish. 

These  and  more  are  included  in  our  first  sec- 
tion, or  "degree,'  of  the  three  of  our  Course. 

However,  in  case  of  large  classes  we  some- 
times divide  these  sections  so  as  to  give  the  full 
Course  in  four  or  more  lessons,  as  may  mutually 
suit  our  time  and  convenience. 

PRINTED  NOTES  FOR  STUDENTS. 

We  have  here  printed  notes  on  the  leading 
and  more  important  points;  one  list  of  them  for 
each  of  the  tlu'ce  sections,  or  lectures. 

Each  individual  of  the  class  is  entitled  to 
these  slips,  which  notes  will  be  explained  by  me, 
in  detail,  in  the  clinic,  and  then  read  aloud  im- 
mediately following  by  someone  of  the  class. 

The  demonstration  and  tlie  reading  together 
will  impress  the  ])oints  on  your  minds,  and  tlie 
preserved  notes  will  be  your  references  in  the 
future,  if  necessary.* 

After  the  reading  of  each  note  any  member 
of  the  class  can  ask  for  any  further  explanation 
he  desires  on  the  points  gone  over.  T5ut  we  '11 
have  no  time  to  listen  to  criticisms^  discussions, 
nor  to  how  you,  or  others,  do  these  things,  until 
the  lecture  is  over. 

But  I  do  want  you  to  ask  pertinent  questions, 
and  even  ask  for  repetitions  until  you  fully  under- 
stand each  point;  then  you  '11  ])robably  have  no 
criticisms  to  offer. 


*This  printed  work  will  now  supplant  the  note  references. 


10  Greexe   Brothers'  Clixical  Course 

Should  you  ask  questions  out  of  time  and 
place,  which  eagerly  interested  students  are  apt 
to  do,  I  will  then  inform  you  that  the  answer  will 
come  in  later,  in  its  order. 

At  the  close  of  each  lecture  we'll  review,  if 
desired;  and  then  again  at  the  close  of  the  Course. 
I  am  no  less  desirous  that  you  fully  catch^on 
than  you  yourselves  are ;  for  I  live  wholl}^  by  what 
my  students  say  of  me  and  of  my  work. 

As  an  incentive  to  my  effort  to  please  and 
to  benefit  I  expect  to  earn,  and  seldom  ever  fail 
to  get,  the  best  recommendation  my  students  can 
write.  (And  I  '11  mention  by  way  of  parenthesis 
I  have  over  a  thousand  such  testimonials,  on  their 
own  letter'heads,  that  I  "point  to  with  pride." 
Scores  of  these,  as  some  of  you  have  seen,  are 
from  the  "best  men"  of  highest  national  stand- 
ing-)"^ 


jUp  to  January,  1914,  about  two  thousand. 


IX  Dextal  Prosthesis.  11 


LECTURE  NUMBER  ONE. 


(Class  close  around  the  table.) 

Doctors:  You  will  now  all  come  up  close 
enough  to  the  clinic  table  to  not  only  hear  my 
whys,  but  see  XJcJiat  I  do,  and  distinctly  hot^  I  do 
things.  For  some  of  the  points  I  will  make  are 
as  "fine"  as  anytliing  you  do  at  your  operating^ 
chair,  or  with  your  blow^pipe.  And  some  things 
here  must  be  done  almost  as  quickly  as  a  snap= 
shot  negative  is  taken. 

But  now  don't  get  scared  at  this  statement, 
for  I  'm  not  going  to  require  of  you  anything 
more  difficult,  or  more  j)articular,  than  many 
things  you  do  in  almost  every  other  operation 
you  perform.  But  I  shall  require  of  you  the 
same  pains  and  exactness  of  manipulation  in 
plate-work  tliat  you  exercise,  for  nicety  and  suc- 
cess, in  other  branches. 

The  patient  who  pays  your  fee  for  a  set  of 
teeth  is  just  as  much  entitled  to  the  best  you 
can  do  as  the  one  who  pays  you  for  a  fine  crown, 
bridge  or  filling.  (Pardon  my  digression  off 
into  professional  ethics — you  are  my  i)atients  for 
the  time.)  Before  we  get  through  the  course, 
you  '11  concede  I  owe  no  apology  for  these  last 
suggestive  remarks. 

A   CLASS   STUDENT   AS   PATIENT. 

I  will  now  need  one  of  you  with  a  liberal 
mouth  and  no  mustache,  at  mv  left  side,  whom 
I  '11  honor  as  "^Nladam." 

Xow,  Madam,  I  want  you  to  sec  me  wash  my 
hands  and  scrub  my  nails  with  clean  water,  soap 
and  a  brnsli,  before  they  go  into  your  mouth.    As 


12  Greene  Brothers'  Clinical  Coi'rse 

a  nice  madam,  of  course,  you  have  no  disagreea- 
ble oral  habit ! 

Now,  ]Madam  Jones,  while  yoii  will  be  my 
main  patient,  I'll  have  an  eye  single,  and  a 
different  finger,  for  the  mouths  of  the  rest  of 
the  class,  opportunely.  (A  spontaneous  lahi' 
lingua  crusade  against  the  "weed"  all  around.) 

You  can  all  best  realize  these  touches  jirst 
in  your  own  mouths;  later  on,  for  practice,  in 
the  hosjjitable  mouths  of  your   mothers-in-law. 

FIRST  HOUR  OF  FIRST  LESSON. 

I  will  mention  here  that  the  jirst  hour  of 
this  threeshour  lesson  is  spent  in  the  general 
manipulation  and  improved  metliods  of  hand- 
ling and  working  modeling  composition,  in  tak- 
ing impression;  first  in  full  cases,  and  then  in 
partial  ones — easy   and   difficult   ones   included. 

Strange  and  unreasonable  as  it  may  seem, 
the  very  inventors  of  modeling  impression  ma- 
terial don't  conceive  of  its  real  possibilities; 
hence,  I  may  add,  only  a  few  produce  an  article 
tdth  needed  possibilities. 

Usually  it  is  condemned  by  the  "best  men"; 
and  well  it  may  be,  as  a  tchole,  if  worked  by  the 
old  methods  in  common  practice.  Xine*tenths 
of  all  "brands"  are  faulty,  even  by  the  im- 
proved methods;  and  all  of  them  practically 
worthless  by  the  old  ways,  and  in  the  common 
spreadsmouth  trays — excepting  in  simple  and 
easy  cases. 

But  with  the  right  material,  used  in  the 
right  handling,  composition  material  is  not  only 
the  best  material,  but  about  all  that  could  be 
desired.  If  this  sounds  "fishy,"  just  wait  and 
see! 

With  it  we  can  take  an  approximate  or  "cor- 
rectable"   impression,    and    adapt   and   conform 


IX   Dextal  Prosthesis.  13 

it  in  detail  to  the  different  tissues  and  muscles 
of  the  mouth,  both  stationary  and  movable,  un- 
til each  place  is  fitted  and  tested  to  a  certainty 
of  correctness. 

And  then  as  a  finished,  completed  result  we 
can  absolutely  test  as  to  its  fit  as  a  ichole  under 
the  practical  movements  of  the  mouth  gener- 
ally; and  then  easily  duj^licate  a  denture  from 
it  that  must  stand  the  movements  the  tested 
imj)ression  stood. 

That  is  to  say:  if  in  a  modeling'Compound 
impression  we  find  that  any  muscular  move- 
ment will  throw  it  down,  or  up,  we  can  change 
and  correct  it,  when  we  know  how. 

Really,  however,  it  makes  little  difference 
of  what  material  an  impression  is  made,  just 
so  it  stands  the  test  of  the  movements.  The 
practical  question  is:  What  material  can  be 
made  to  conform  to  the  moving  nuiscles,  giv- 
ing them  room  to  move  in  freely,  and  yet  press 
with  valve-like  tightness,  giving  relief  tcithout 
leak? 

These  are  the  essential  qualities  of  any  ma- 
terial  for   teivt  impressions;  we  trust  no  others. 

Xow,  it  is  for  me  to  sliow  you  what  should 
be  done,  how  to  do  it,  and  what  to  do  it  with. 

WHAT  WE  WANT  TO  DO  IN  TAKING  AN  IMPRESSION. 

In  taking  an  inqiression,  the  main  three 
points  to  be  attained  are:  (a)  the  correct  height 
and  lengtli  of  tlie  expectant  })late;  (b)  about  an 
equal  strain  on  the  stationary  hard  and  the  soft 
parts  of  the  covered  mouth,  at  about  the  pres- 
sure it  is  to  be  worn;  then  (c)  room  for  tlie 
movable  i)arts  to  move  in  and  still  be  valve- 
like tight.  That  is  to  say,  again,  relief-without* 
leak  in  muscular  motion. 


14'  Greene  Brothers'  Clinical   Course 

If  taken  at  a  much  harder  pressure  than 
the  plate  is  to  be  worn,  the  tissues  will  be  dis- 
torted, and,  of  course,  the  plate  will  not  fit 
when  the  parts  are  not  strained,  but  must  come 
back  to  their  normal  position.  It  looks  like 
everybody  ought  to  think  of  this,  but  only  a 
few  do. 

Let  me  close  my  left  hand  and  call  the  back 
part  of  it,  including  my  knuckles,  a  mouth, 
with  hard  and  soft  j)arts.  The  knuckles  are 
the  hard  parts  and  between  the  knuckles  the 
soft  parts. 

Now^  contrary  to  the  general  teaching,  you 
always  get  the  impression  of  the  hard,  station- 
ary parts  right.  No  matter  what  material  you 
use  or  pressure  you  give,  you  get  the  impres- 
sion of  the  hard  parts  about  right — right  in 
proportion  to  their  solidity. 

You  think  your  plates  rest  too  hard  on  the 
hard  parts,  and  are  told  to  scrape  them  there 
and  "relieve"  them.  Absurd,  for  thej^  are  right, 
in  proportion  to  the  hardness  under  them. 

If  anything  is  wrong,  it  is  on  the  soft  parts, 
or  else  the  movable  hard  parts;  which  exception 
we  '11  consider  in  a  fe^^-  minutes. 

See  me  press  with  my  right  index  finger  be- 
tween the  knuckles  on  my  left  fist.  The  tissue 
is  soft  and  it  yields.  Just  so  do  the  soft  parts 
in  the  mouth  give  when  you  take  an  impression, 
with  either  modeling  compound  or  thick  plas- 
ter. But  the  knucldes  don't  y\e\d — excepting 
that  of  the  left  little  finger. 

Now  for  the  impression,  supposing  it  to  be 
of  my  hand.  To  get  it  correct  we  must  make 
this  soft  tissue  yield  just  enough  to  give  us  a 
pressure  about  equal  with  that  on  the  knuckles, 
at  about  the  strain  the  denture  is  to  be  worn. 

If  we  press  too  hard  on  the  soft  parts  and 
strain  them  too  much,  thev  will  rebound  when 


IX  Dextal  Prosthesis.  15 

we  cease  the  pressure,  and  will  lift  the  impres- 
sion (or  plate)  off  the  hard  parts;  in  which  case 
there  would  be  air  under  it,  over  the  hard  parts. 
And,  of  course,  the  air  there  would,  to  some 
extent,  offset  and  neutralize  the  air  pressure 
from  the  opposite  (upper)  side.  In  other  words, 
our  "suction"  (atmospheric  weight)  would  be 
lessened. 

But,  on  the  other  hand,  if  we  press  too  light- 
ly on  the  soft  parts  and  don't  make  them  give 
any  at  all,  the  impression  (or  plate)  will  rest 
so  loosely  on  them  as  to  admit  of  air  there;  and 
again  we  'd  have  lessened  atmospheric  pressure. 

Atmosplieric  pressure  and  "suction"  are  syn- 
onymous terms.  Whenever  there  is  any  air  un- 
der a  plate,  however  rarefied  it  may  be,  the 
"sticktion"  will  be  lessened  accordingly. 

So,  when  you  don't  press  the  soft  parts  up 
with  enough  strain,  you  say  your  plate  rests 
too  hard  on  the  hard  places.  This  isn't  ex- 
actly true — only  relatively  true,  since  the  bear- 
ing is  correct  on  the  hard  parts,  and  lacking 
elsewhere. 

"Perfect  adaptation"  means  a  similar  strain 
on  the  hard  and  soft  places;  but  atmospheric 
pressure,  or  "suction,"  is  what  holds  an  upper 
plate  to  its  place — unless  clasps  or  other  clap* 
trap  means  are  used. 

I  '11  merely  remark  here,  a  little  premature- 
ly, that  I  '11  show  you  later  on  in  this  lesson 
that  it  takes  surprisingly  little  "suction"  to 
hold  a  plate  u])  if  it  has  no  strain  to  throw 
it  loose. 

But  ecpialized  strain  on  the  hard  and  soft 
parts  isn't  all,  nor  even  the  most  important 
thing,  to  be  obtained  in  this  matter.  We  have 
movable  parts — muscles  and  tissues — that  must 
be  accommodated,  as  vou  here  see  on  and  around 


16  Greene  Brothers'  Clinical  Course 

my  little  finger's  moving  knuckle,  as  I  tighten 
and  loosen  my  hand's  grip. 

Xow,  in  a  plate,  and  consequently  in  our 
impression,  we  must  provide  for  this  movement; 
or  it  will  lift  it  up,  if  a  lower  one,  or  work  it 
loose,  if  an  upper  one. 

Tliis  is  usually  done  (old  way),  or  rather  at- 
tempted to  be  done,  by  scraping  the  plate  after 
it  is  made;  or  by  trimming  the  impression  with 
a  knife — both  by  guess. 

The  moving  muscle,  or  other  moving  part, 
must  not  only  have  room  to  move  in,  but  it 
must  move,  as  we  say,  valve=tight,  air-tight. 
Otherwise  air  w411  get  under  it,  and  away  goes 
your  "suction,"  your  atmospheric  hold. 

ALL  MOVING  TISSUES  MUST  MOVE  AIR=TIGHT. 

Xow%  doctors,  get  yourselves  fully  impressed 
with  this  essential  fact  in  plate^work.  But  who 
can  file  and  scrape  impressions,  models,  and 
plates,  so  a  muscle  can  work  freely  and  yet  be 
air'tight?  Or,  as  we  say,  valve=tight,  similar 
to  a  piston  in  a  tube  syringe? 

"Guess*work  is  as  good  as  any  wlien  it  hits." 
But  how  many  can  guess  out,  or  guess  ofT.  room 
for  a  straining  muscle  to  move  with  valve^tight 
pressure?  Only  the  experienced  few,  and  then 
only  in  easy  cases. 

We  have  a  way  of  making  this  air=tight 
working  room  without  file  or  scraper;  and,  too, 
without  guessing. 

This  is  done  by  a  method  of  nmscle^trim- 
ming,  soon  now  to  be  demonstrated,  in  this 
lesson. 

AN    APPROXIMATE,    CORRECTABLE    IMPRESSION. 

We  first  take  an  approxiamte,  "correctable" 
impression;   which   is  but  a  modeling^compound 


IX    Dental    Prosthesis.  17 

tray  within  a  metallic  tray.  By  "correctable" 
I  mean  one  that  has  none  of  the  metal  tray 
in  sight. 

Then  we  transform  this  correctable  impres- 
sion, or  tray,  into  an  accm*ately  fitting  tcs-t  im- 
pression; at  some  detail  when  necessary. 

FIT  METAL  TRAY  TO  THE  MOUTH. 

To  avoid  straining  the  tissues  and  distort- 
ing the  mouth  to  be  covered,  we  use  only  shal- 
low, or  low=rimmed,  metal  trays — never  deep 
ones. 

These  trays  are  always  lower  on  rim  and 
shorter  in  length  than  our  finished  plate  is  to 
be;  and  never  steep  in  the  roof,  lest  we  strain 
the  back  palate  with  metal  and  then  lack  ma- 
terial for  correcting  the  strain. 

Our  metal  trays  are  low,  also,  in  order  that 
we  may  not  strain  the  lip=andscheek  tissues; 
and  further  that  we  may  have  material  above 
the  rim  which  can  be  reduced  or  extended  in 
transforming  the  modeling  =  composition  tray 
into  an  impression. 

Should  you  ever  need  a  deeper  metal  tray 
(very  seldom),  you  can  trace^on  an  edge  of  mod- 
eling compound  from  a  round  stick  of  the  same 
material  as  the  impression,  heated  over  a  spirit 
lani]) — here  shown. 

This  traced^on  rim  is  hard  when  you  want 
it  hard  and  wdll  be  soft  when  so  needed.  For- 
merly I  used  common  sealing=wax  to  ])uild  up 
the  edges  of  my  metal  trays;  but  these  (Kerr's 
"Perfection"*)  sticks  are  better,  from  the  fact 
that  these  rims  become  a  part  of  the  finished 
impression. 


I    know    of   1)11   otluT    tlwit    we'll    tr;icf    so    wi-U    a->    this    Kerr's 
"Perfection." 


[2] 


18  Greexe   Brothers'  Clixkal   Course 

TWO   WAYS   TO   FIT   TRAY. 

For  this  we  have  two  methods:  the  student's 
method  and  the  practitioner's  method.  I  '11 
first  give  you  the  student's  way.  It  is  to  first 
take  a  common,  hurried  impression  "any  old 
way,"  and  make  a  hurried  model  from  it;  and 
then  fit  a  tray  to  this  a]j]jroximate  model,  in- 
stead of  fitting  it  to  the  mouth  itself;  the  lat- 
ter being  the  practitioner's  method. 

The  student's  method  is,  in  fact,  a  good  one 
for  even  the  most  experienced,  who  are  willing 
to  take  a  little  extra  time,  say  five  minutes,  to 
first  get  this  approximate  plaster  model.  Indeed, 
it  is  the  preferable  way,  and  becomes  the  settled 
one  with  many  of  my  students  in  practice. 

Well,  I  have  a  model  here  before  me.  We  '11 
suppose  it  to  have  been  made  by  some  one  of 
you  from  a  hurried  common  imi^ression — ^^or,  as 
for  that,  from  a  "good"  impression  ("good," 
but  untested  and  not  knozcn  to  be  good). 

AVe  '11  take  an  old,  soft=metal  tray  and  cut 
it  off  at  the  heel  so  as  to  be  a  little  shorter  than 
we  think  our  coming  plate  should  be.  judging 
from  the  model;  and  then  we  '11  trim  it  down  at 
the  sides  and  in  front,  so  as  not  to  be  quite  as 
high  as  we  think  our  plate  should  be. 

AVe  '11  thus  make  it  seemingly  about  a  full 
one-eighth  of  an  inch  too  short  and  too  shallow 
all  around.  And  we  '11  fiatten  it  down  so  as  to 
have  very  little  elevation  in  the  center.  If  we 
get  its  rim  an  eighth  of  an  inch  really  too  low. 
no  harm  done;  for  our  impression  material  will 
become  a  rim  of  itself. 

Then  ^\e  want  the  metal  tray  a  little  larger 
than  oiu-  model  (or  mouth),  so  as  to  work  loose- 
ly over  it;  say  with  a  scant  eighth  of  an  inch 
play  all  around  it. 


IX   Dextal   Prosthesis.  19 

It  is  easier,  at  least  for  a  novice,  to  fit  a 
metal  tray  to  a  model  than  to  a  mouth.  Ex- 
perienced practitioners  can  readily  fit  it  to  the 
latter.  But  whichever  way  you  do  it,  fit  your 
tray  thus,  to  within  an  eighth  of  an  inch  of  the 
gums  all  around;  and  always  shy  of  the  attacli- 
hig  muscles  of  the  li])  and  cheek,  so  the  metal 
won't  strain  them  in  the  least. 

Don't  let  your  metal  tray  run  up  high  he- 
hind  the  tuberosities  so  as  to  strain  the  tissues 
there.  Bear  in  mind,  1  repeat,  i/our  metal  tray 
mustn't  .strain  the  tissues  ani/ichere;  espeeiall// 
not  the  muscular  tissues.  (Stick  a  pin  in  that 
essential  fact.) 

After  long  effort.  1  liave  succeeded  in  getting 
some  Greene-Method  trays  made  on  purpose  for 
those  who  may  learn  their  advantage.  There 
are  for  the  present  ten  in  a  set;  and  so  shallow 
in  depth,  and  otherwise  so  shaped,  as  to  re- 
quire a  minimum  of  change.  They  are  manu- 
factured by  the  Detroit  Dental  ^Manufacturing 
Coni]^any,  Detroit.  Mich.  While  you  can  cut 
your  old  trays  down  and  shape  them,  as  I  show 
you,  yf)u  can  get  more  appropriate  new  ones. 
Ours  have  removable  handles,  the  advantages  to 
be  shown  later  on. 

THE  FITTED  METAL   TRAY. 

Xow  you  have  fitted  your  metal  tray,  either 
to  the  approximate  model  or  to  the  mouth  it- 
self, in  a  way  to  leave  space*room  for  your  com- 
pound to  hide  it  (the  tray)  when  your  correct- 
able impression  is  first  taken.  That  is.  the  im- 
pression material  must  cover  the  metal  trays 
all  over.  The  metal  can't  be  mani])ulated:  the 
material  can  be — one  reason  for  l()w=riinined 
travs. 


■20  Greene   Brothers"   Ci.ixical   Course 

Be  sure  your  tray  either  has  holes  through 
it  or  else  is  well  smeared  with  aetually  adher- 
ing compound  before  you  place  that  for  the 
impression  on  it,  to  insure  sticking  safely.  And 
I  '11  here  remark  in  advance:  Be  especially  care- 
ful in  fastening  impressions  to  metal  trays  in 
partial  cases. 


IX   Dkxtal   Prosthesis. 


21 


Fig.  1. 


Fis 


Fig.  1. — Average  deep  tray  before  eiit  down  and  fitted  to  the 
mouth.  Its  high  rim  would  distort  tlie  tissues.  All  trimming  of 
plates  from  impressions  in  it  must  l)e  In'  unreliable  file-guess-work. 

Fig.  2. — Same  tray  after  cut  down  and  fitted  to  the  mouth. 
Can  be  deepened,  if  necessary,  witli  modeling  compound  traced  from 
Kerr's  tracing-sticks.  Then  the  impression  rim  can  be  accurately 
muscle-trimmed. 


Fig.  3. 

Handle  can  be  removed  for  nuiscle-trimminf 
impression  fills  out  the  lips  and  cheeks. 


and  to  show  how 


22  Greexe   Brothers'  Clixical  Course 

NOW  TAKE  YOUR   CORRECTABLE  IMPRESSION. 

This  I  A\ill  ti^^t  illustrate  in  detail.  Then, 
when  you  understand  it  in  detail.  I  "11  unite 
these  details  as  we  "d  do  it  in  a  practical  op- 
eration. You  "11  combine  as  many  details  as 
your  case  and  your  experience  may  warrant. 
But  first  learn  the  principles  iu  dissection  and 
practice  them  in  detail,  till  you  can  safely  unite 
them. 

TWO    METHODS    OF   TAKING    CORRECTABLE 
IMPRESSIONS. 

We  also  teach  two  methods  of  taking  a  cor- 
rectable imjDression : 

(a)    The  student's  method,  and 

(h)    The  practitioner's  method. 

The  practitioner  can  often  use  the  student's 
method  to  advantage,  but  the  novice  in 
impression=taking  would  best  learn  by  the  stu- 
dent's nit'thod. 

STUDENT'S    CORRECTABLE    IMPRESSION. 

Take  your  no^\•  lifted  tray,  with  its  low  rim 
and  short  rear,  and  take  an  impression  of  the 
same  model  you  fitted  the  tray  to.  This  will 
give  you  an  approximate  impression  with  a  mar- 
gin of  material  above  the  metal  rim  and  behind 
the  metal  tray.  It  may  be  so  lacking  as  not  to 
deserve  the  name  ''impression."  It  '11  be  merely 
a  modeling^composition  trai/.  It  will,  however, 
be  your  student's  correctable  impression. 

To  take  this  correctable  impression  of  the 
model,  you  first  dust  it  with  flour  of  soapstone. 
so  the  impression  won't  stick  to  it.  "And  don't 
ijou  forget  it!" 

To  separate  them,  you  first  chill  the  im- 
pression a  little;  then   pull  it  away  a   little  bit 


IX    De.vtal    Prosthesis.  23 

from  the  iiKKlel  at  the  heel,  or  tuberosity.  Then 
quick=dip  in  cold  water  to  let  it  (the  water)  in 
between  the  impression  and  model,  and  very 
qiiich'If/  hard^squeeze  them  back  together,  to  re- 
store shape  to  the  impression;  for  it  probably 
sprung  some  in  the  })artial  removal.  Then  take 
the  model  out  of  the  impression  and  cool  it 
thoroughly.  Should  you  neglect  to  pull  the  im- 
pression a  little  away  from  the  model  while  it 
is  yet  warm  in  the  interior,  as  shown,  vou  may 
have  diificulty  in  getting  it  off  when  cold. 

The  next  thing  would  be  to  transform  this 
.correctable  impression,  or  compound   trai/.  into 
a  perfect  tested  impression.      But  before  we  do 
it.  we  '11  take  up 

(First  Step.) 

THE    PRACTITIONER'S    APPROXIMATE    IMPRESSION. 

So  now  we  "11  stop  to  take  a  similar  cor- 
rectable impression  by  the  practitioner's  (cut* 
short)  method.  Then  we  11  lit  each  of  these 
approximate  impressions  to  the  mouth,  in  about 
the  same  manner. 

To  take  a  correctable  impression  from  the 
mouth  (practitioner's  way),  instead  of  from  the 
approximate  model  (  students  way  > .  place  the 
"Perfection"  compound  in  a  small  pan  of  water 
with  rubber  dam  under  it  to  prevent  sticking. 
Heat  is  some,  but  not  hot  enough  to  scald  your 
lingers. 

\Vitli  your  hands  and  fingers  well  wet  with 
warm  water  roll  the  material  into  a  ball:  place  it 
in  a  tray.  linger=press  or  fashion  it  to  approxi- 
mately fit  the  mouth,  but  cone'.shaped  is  eenter. 
with  full=high  rim  all  around. 

The  cone=shape  is  to  insure  its  striking  the 
center   of   the    mouth    first   and   scattering   out- 


2t  Greene    Brothers'  Clixical   Course 

wardly;  a  matter  of  especial  importance  in  deep 
arches.  All  impressions  of  all  materials  must 
scatter  from  the  center  out^^•ardlv. 

With  your  material  well  shaped,  now  pass 
it  back  and  forth,  laterally,  over  a  small  hand* 
spirit*lamp  flame,  to  soften  the  surface  to  a 
semi^flowing  consistency,  not  quite  hot  enough 
to  burn  your  fingers  at  a  test=touch.  Ahcai/s 
have  your  fingers  zcet  with  warm  water.  Tell 
your  patient  it  's  quite  warm,  but  not  hot  enough 
to  burn.    Don't  forget  this  precaution. 

Xow,  with  your  left  arm  around  your  pa- 
tient's head  (her  head  forward  rather  than  back- 
ward) and  the  long  finger  of  your  right  hand 
in  the  under-center  of  the  tray,  push  upward 
gently,  with  an  up=tension,  wave*like  motion : 
an  up'ward  spring-like  pressure,  mind  you. 

Push  light] If,  for  impressions  should  be  taken 
at  about  the  strain  plates  are  to  be  worn.  (This 
point  is  worth  repeating  in  your  prayer  for  suc- 
cess. ) 

Technically  speaking  the  proper  strain  would 
be  just  what  the  patient  would  use  in  sucking 
the  impression  up. 

If  the  roof  of  the  mouth  is  deep,  pull  forward 
a  little  while  you  are  playing  upward,  in  order 
to  strike  the  front  palate  right=angle*ward;  for 
modelingscomposition  impressions  should  be 
taken  at  about  right  angles  at  all  points,  as  well 
as  to  about  the  normal  sucking  plate=pressure. 

When  you  have  it  pushed  to  place,  hold  it 
steadily  until  you  reach  around  to  the  right 
side  of  the  face  and  with  the  index  finger  of 
the  left  hand  adroitly  flip  up  the  squashed 
material  that  overlaps  the  rim  of  the  metal 
tray  there. 

Then  remove  your  right-hand  central  finger, 
aforesaid,   and   dextrously    change   off   to   your 


IX   Dental   Pkostiiesis.  25 

left'lmnd  middle  finger,  in  place  of  the  right- 
hand  one.  Hold  as  before  while  you  reach 
around  and  flip  up  the  left  overlapping  ledge 
with  the  right*hand  index  flnger.  (Don't  get 
hands  and  Angers  mixed  up. ) 

I  mean  quickly  push  the  compountl  up  above 
the  edge  of  the  tray  all  around;  but  not  tightly 
against  the  gums — for  reason  given  later  on. 

Xow,  right  aicaij,  while  the  material  is  still 
soft,  tell  i)atient — and  show  her  how — to  work 
the  rim  of  the  im])ression  down  by  hp*and*cheek 
motion.  By  prompt  movement  of  your  own 
lips  you  will  prompt  her.  (And  you  must  do 
this  familiarly  yourself  to  impress  your  patient 
to  do  it.    Get  before  a  mirror  and  practice.) 

Hold  up  impression  flrmlv  with  vour  right- 
hand  middle  flnger  while  patient  gets  a  quick 
move  on  her  and  obeys  orders. 

This  lip=and=cheek  movement  gives  you  the 
approximate  height  of  the  impression — not  the 
exact  height. 

Xow  to  cool  it.  Again  change  to  left  flnger 
and  hold  while  with  your  right  hand  you  reach 
to  your  cup  of  cold  water  and  get  a  little  sponge, 
about  the  size  of  a  small  ))lack  walnut,  and  hold 
it,  ice=cold,  up  against  the  under  roof  of  the 
metal  tray  for  a  full  half*minute,  to  cool  the 
im])ression. 

PRACTITIONERRS  PARTIAL  TEST  FOR  FIT. 

When  cold,  let  go  the  tray.  If  the  impres- 
sion stays  in  place  ( without  any  muscular  move- 
ment to  dislodge  it),  that  proves  it  flts  the  roof 
and  alveolar  ridge;  all  the  fit  you  want  note. 

You  know  it  flts  there,  because  it  stays  up 
without  fltting  anywhere  else.  You  've  never 
pressed  it  to  the  gums  on  the  side  nor  at  the 
back    palate;    hence   the    stick    must   be    at    the 


26  Greene   Brothers'  Clinical  Course 

center  and  on  the  ridge — just  what  you  want 
for  the  present. 

This  is  the  iesi  for  the  center  and  ridge  fit. 
And  I  '11  assure  j^ou  that  if  you  do  this,  as  I  've 
told  you  and  here  shown  you,  you  '11  not  fail 
to  get  this  center'fit  once  in  fifty  times.  That 
is,  to  repeat:  by  coning*up  your  material  in  the 
center,  warming  it  to  a  half-flowing  condition 
over  a  spirit  flame  and  pressing  it  up  by  wave* 
motion,  at  normal  wearing  plate=pressure,  suction 
pressure. 

Now  you  've  taken  your  correctable  impres- 
sion by  the  practitioner's  method;  and  you  have 
about  the  same  results  as  by  the  student's  meth- 
od, onlii  that  you  have  a  tested  fit  to  the  roof 
and  ridge,  which  the  student  liasn't. 

SUPPOSE  IT  DOESN'T   CENTER-TEST. 

But  now,  doctors,  for  convenience  of  in- 
struction, we  '11  suppose  that  once  in  a  while 
we  mat/  fail  to  get  tliis  i"oof=fit  by  the  practi- 
tioner's method.  We  '11  then  first  get  the  ex- 
act length  which  the  plate  is  to  })e  at  the  back 
palate,  and  proceed  to  correct  the  roof  and  ridge 
till  it  does  test^fit. 

^lark  this  point  in  our  work:  AVe  make  no 
roof  correction  until  we  first  get  the  exact  length 
of  our  impression  at  the  rear,  Xor  do  ^ye  do 
both,  the  correction  and  getting  the  length,  at 
the  same  step  into  the  mouth, 

{Seeond  Step.) 

TRIM  IT  APPROXIMATELY. 

We  have  before  us  our  correctable  impres- 
sion. In  this  case  it  fits  nowhere  correctly  yet. 
Now,  our  second  step  is  to  complete  its  ap- 
proximate trimming. 


IX   Dental   Prosthesis.  27 

Its  rim  has  already  been  trimmed  aj^prox- 
imately,  as  to  height,  by  the  H]J=and*cheek  mo- 
tion of  our  patient,  "^ladam"'  (usually  one  of 
the  class)  ;  but  its  sides  are  thicker  than  we  "11 
\\ant  them  to  be  in  our  next  move,  so  we  11 
thin  them  down  a  little. 

I  will  touch  the  sides  slightly  to  this  man- 
agea})le  liand=lamp  Hame  and  shave  them  down 
with  this  sharp  poeket=knife  to  about  three  times 
the  tliickness  we  'd  want  an  ordinary  finislied 
plate  to  be.  We  ^^arm  it  \'ery  slightly  to  cut 
more  easily. 

Xext,  we  '11  cut  the  impression  oft*  at  the 
rear,  leaving  it  a  little  longer  than  we  think 
our  finished  plate  sliould  be;  say  at  least  an 
eighth  of  an  inch  too  long.  If  it  weren't  that 
long,  we  (1  take  a  tracing=stick  of  Kerr's  "Per- 
fection" material  (same  as  the  rest  of  the  im- 
pression )  and  trace^on  to  wanted  length,  ( Here 
the  fine  art  of  tracing-on  is  shown  objectively 
to  tile  dee])  interest  of  the  class.) 

But  now,  before  we  show  how  to  get  the 
CiVact  lengtli  of  a  plate  at  tlie  rear,  we  must 
understand  what  length  it  should  be.  TJiat  is 
one  of  the  most  important  matters  in  phite= 
work — if  a  roof  is  to  be  left  at  all.  In  many 
mouths  a  roof  isn't  at  all  necessary;  and  in  some 
actually  detrimental.  But  where  used,  the  cwact 
CiVtott  is  often  a  very  close  ])oint  to  make. 
'  In  some  mouths  even  an  eighth  of  an  inch  or 
less  would  cause  sticktion,  or  ])revent  it;  then 
again,  in  othei's  we  have  a  latitude  of  a  quarter 
or  third  of  an  inch  margin  to  go  on. 

AVhat  we  want  is  to  reach  onto  the  stationary 
soft  parts  and  yet  not  onto  the  movable  soft 
parts. 

If  we  don't  get  onto  the  yieldable  soft  and 
press  it  up,  our  plate  will  tip  down  behind  eas- 


28  Greene   Brothers'  Clinical  Course 

ily.  And  if  we  get  onto  the  movable  soft,  it 
may  move  and  push  the  plate  down;  or,  at  least, 
cause  "gagging." 

Xow,  can  we  make  that  fine  line  of  demai'k- 
ation  between  the  stationary  soft  and  the  mov- 
able soft  tissues  at  the  rear  of  our  impression? 
If  we  can't,  we  may  fail. 

TO  GET  LENGTH  OF  PLATE  IN  A  SOFT  MOUTH. 

If  the  mouth  is  what  we  call  a  soft  one  (no 
hard  palate),  we  find  this  line  with  close  pre- 
cision by  the  ordinary  swallowing  movement 
That  is,  we  thin  down  the  impression  from  the 
under  side  ( it  piu'posely  being  a  little  longer  than 
the  metal  tray)  until  the  edge  is,  say,  an  eighth 
of  an  inch  or  so  thick,  and  a  little  bit  longer 
than  we  think  a  plate  should  be  in  that  mouth. 

Then  we  warm  this  thin,  projecting  edge  at 
the  side  of  the  little  spirit=lamp  flame  till  it 
will  yield  readily  to  the  touch  of  our  finger, 
but  not  biu'n  it. 

Then  we  slip  the  impression  into  the  mouth 
quickly  and  have  patient  bite  down  on  our  fin- 
ger and  promptly  swallow  a  time  or  two.  She 
has  to  bite  down  on  something  to  enable  her 
to  a  good  effort. 

Now  she  has  swallowed  boldly.  We  take 
the  impression  out  and  find  the  rear  of  it  turned 
down,  as  far  as  the  moving  parts  moved;  and 
ordy  that  far. 

We  chill  it  in  cold  water  and  trim  off  to 
where  it  turns  down.  We  may  do  this  a  sec- 
ond, or  even  a  third  time,  if  necessary  to  make 
sure  of  the  all=important  point. 

This  procedure  will  give  us  the  proper  length 
of  the  plate  ninety  or  more  times  in  a  hundred, 
if  done  rightly.  And  in  the  other  ten  or  less 
times  in  a  hundred  the  failure  would  show  up 


IX    Dental   Prosthesis.  29 

when    we   made   our   final   test   of   finished    im- 
pression; which  we  can  then  correct. 

(The  process  is  here  shown  closely  to  each 
one  in  the  class. ) 

TO  FIND  LENGTH  FOR  PLATE  OVER  A  HARD  PALATE. 

The  method  just  described  is  for  a  mouth 
Mith  a  soft  roof.  We  have  an  easier  and  quick- 
er way  of  finding  the  length  of  an  impression 
(or  plate)   in  a  mouth  with  a  hard  palate. 

Doctors,  you  have  never  taken  an  impres- 
sion of  a  hard'palate  mouth  that  didn't  show 
just  wjiere  the  hard  reached  to.  You  can  gen- 
erally see  it  quite  plainly.  And  such  an  im- 
pression always  tells  you  itself  just  where  to 
cut  it  off;  at  least,  where  not  to  cut  it  off.  Tliat 
it  will  not  do  to  cut  it  off  on  the  hard  part 
will  hear  repeating — ^^Several  times  if  necessary. 
It  'd  ihcn  easily  ti])  down,  not  having  a  valve*like 
pressure. 

Cut  it  off  at  least  one==eighth  of  an  inch  back 
behind  the  limit  of  the  hard  part;  even  a  quar- 
ter of  an  inch  is  often  advisable.  Just  so  you 
don't  let  it  reach  onto  the  movable  soft  part; 
in  which  case  it  would  "swallow  do\Mi,"  or 
"gag"  badly. 

To  repeat  the  ride:  Reach  onto  the  station- 
ary soft  part  without  encroaching  onto  the  mov- 
aJ)lc  soft  part.  This  valve=j)ressure=line  demark- 
ation  is  always  an  eightli  of  an  inch  wide — 
generally  more.  Pretty  soon  I  '11  show  you 
how  I  make  the  essential  valve  ])ressure  thereon. 

And  a  little  })rematurely  1  "11  here  mention 
that  we  must  reach  the  soft  tissue  and  make  this 
coming  valve^pressure  fit  extend  clear  around 
on  the  plate^tosbe — l)ehind  the  tuberosities  and 
all. 


30  Greexe  Brothers'  Clinical  Course 

We  must  have  an  equalized'pressure  fit  all 
over  it  and,  additionally,  a  valve^pressure  fit 
all  around  the  edges.  We  must,  by  detail  when 
necessary,  transform  the  non-fitting,  correctable 
impression  wholly  into  a  correct  one  and  test 
it  finally  to  knotc  that  it  is  correct  everywhere. 

W^e  now  have  the  rules  for  finding  the  length 
of  an  impression  (consequently  plate)  for  either 
a  hard  or  soft  palate.  We  class  the  medium 
with  a  soft  palate.  A  hard  one  is  where  yon 
can  see  in  the  impression  of  any  ^^I'oper  ma- 
terial just  where  the  hard  reaches  to. 

{Third  Step.) 

CORRECT  ROOF  TO  TEST=FIT. 

We  now  have  the  approximate  height  of  rim 
and  true  length  of  impression.  However,  if  at 
any  point  the  rim  is  lacking,  we  "W  just  trace-on 
as  much  as  is  needed,  as  I  have  shown  you. 

This  tracing-on  of  additional  material  will 
be  more  frequently  required  beliind  tuberosities 
than  anywhere  else,  because  in  some  mouths 
you  can't,  in  the  first  place,  get  your  finger  up 
there  in  the  mouth  to  push  it  up. 

We  '11  first  trace^on  the  required  material 
and  then  approximately  place  it,  with  wet  fin- 
gers. We  '11  adjust  it  correctly  when  we  so  treat 
the  rest  of  the  rim. 

Xow  we  are  ready  to  make  tlie  correct  jit 
to  the  roof  and  ridge,  which  shoidd  have  been 
accomplished  when  we  first  took  oiu*  correct- 
able impression,  and  which  will  l)e  accomplished 
ninety-five  times  in  a  hundred  if  done  as  shown 
you.  Well,  this  roof  correction  is  quickly  and 
easily  made. 

We  have  here  a  common  tin^cup  with  a  spout 
like  that  of  a  teapot,  near  its  top,  that  will  pour 


IX   Dental   Prosthesis.  SI 

a  stream  about  the  size  of  a  ten52>eiiny  nail. 
From  it  we  iJoui-  h(jt  water  into  the  impression 
until  it  fills  up  to  within  an  eighth  of  an  inch 
from  the  top. 

We  pour  on  and  on,  the  hot  water  running 
off  at  the  heel.  We  '11  not  heat  quite  to  the 
top  of  the  rim,  however;  the  patient's  lips  would 
then  turn  it  over  the  wrong  way  when  we  'd 
insert  it  in  her  mouth. 

We  '11  get  the  center  as  soft  as  we  can  ^^•ith- 
out  burning  the  mouth.  And  here  the  Kerr 
"Perfection"  has  rare  possibilities.  We  quicldif 
insert  it  and  immediately  wa\'e=2)ress  lightltf — 
quickh',  for  haste  here  is  absolutely  essential  to 
success.  To  simx)ly  see  this  is  to  learn  //oic; 
but  with  slow  people  sufficient  quickness  may 
have  to  be  acquired  by  practice. 

Xow,  the  question  simply  is:  Can  //ou  do 
this  quickly  enoughs  If  not,  why,  then  not  at 
all.  Xo  physical  stupidity  nor  poke^andsgO' 
easiness  will  fit  in  here.  If  you  can,  you  '11 
seldom  fail  in  the  first  effort. 

But  the  hot'pot  pouring  and  other  efforts 
must  be  repeated  until  the  impression  will  stand 
a  roof^fit  test;  /.  r..  hang  there  snugly,  with  no 
muscular  movement  to  loosen  it. 

Take  notice,  now,  if  we  have  made  much 
change  in  the  impression  in  this  "equalizing" 
work:  we  may  find  a  little  bit  of  a  roll  of  com- 
pound showing  up  where  the  hot  and  cold  points 
met  on  the  inside  of  the  rim.  If  so,  we  '11  scrape 
it  off  down  even,  before  we  forget  it. 

While  this  roof^correcting  step  is  very  sel- 
dom necessary  in  the  ])ractiti(mer's  method,  it 
is  very  fre(|uently  needed  with  the  student's 
method.  It  de])ends  on  whether  or  not  the  coni- 
])ouii(l  is  coned=u])  iji  the  center,  softened  thor- 


.'52  Greene   Brothers'  Clin'ical   Coirse 

oughly,  and  pushed  up  with  right  motion  at  a 
proper  angle  and  due  strain. 

I  'd  hke  to  both  whisper  and  "holler"  these 
essentials  in  the  ears  of  all  plate*making  dentists. 
I  could  save  them  so  much  trouble. 

(Fourth  Step.) 

CORRECT  RIM  TO  MUSCLES. 

This  is  to  get  the  precise  height  of  the  plate' 
rim  everyxicliere,  including  behind  tuberosity,  and 
especially  to  get  a  correct  fit  to  the  moving, 
■straining  tissues. 

I  don't  mean  to  get  for  them  merely  relief 
from  strain,  but  a  sort  of  accommodating  pres- 
sure to  them,  with  ample  room  for  air=tight 
movement.      We  christen  the   gratifying  result 

RELIEF=WITHOUT=LEAK — THE  PERFECTION 

COMPOUND  IMPRESSION 

"PASS=WORD." 

We  accomplish  the  precisi(ni  in  part  by  a 
system  of  muscle=trimming  on  sensitized  edges. 
We  take  our  approximately  trimmed  impression, 
warm  the  edge  of  the  rim  slightly  all  around, 
including  tuberosities,  and  pinch  it  up  a  little. 
This  })urposely  brings  it  up  a  little  too  high 
and  somewhat  thin  at  its  very  top. 

This  extra  high  rim  we  norc  warm  quite  soft 
to  a  very  shallow  depth,  insert  it  in  the  mouth, 
and  with  quick,  positive  movements  of  the  lips 
and  cheeks  w^ork  it  down  to  the  proper  height, 
to  fit  the  moving  muscles. 

This  I  give  you  as  an  advance,  liurried  pre- 
lude to  what  we  do.  Xext  I  '11  ".shore"  ijoii. 
(From  ^Missouri.) 

Xow  watch  me  closely.  By  the  side  of 
this  little   hand'Spirit*lamp   flame   I    warm  this 


IX   Dental   Prosthesis.  33 

pinched*up  edge  (one  side  at  a  time  in  many 
cases)  very  soft  to  the  depth  of  about  an  eighth 
of  an  inch. 

Now  I  '11  slip  it  into  the  mouth  very  quicldy, 
and  have  patient  promjitly  make  all  possible 
movements  of  her  lips  and  cheeks  that  she  'd 
make  in  wearing  a  plate.  I  usually  do  this  one 
side  at  a  time. 

Take  notice:  (a)  very  soft;  (b)  to  a  very 
shallow  depth;  and  (c)  all  done  very  quickly. 
Three  "very" a.  "Stick  a  pin"  in  to  hold  these 
three  "very"s! 

Well,  to  impress  you  I  '11  baptise  this  stunt 
in  New  River  and  name  it 

VERY'EDGING  OR  MUSCLE -TRIM- 
MING, 

So  I  ha^'e  trimmed  the  rim  of  the  impres- 
sion, hence  the  plate,  too,  by  muscle  movement. 
Everj^  tissue,  hard  and  soft,  has  cut  its  way  into 
this  "very"  soft  rim  (over  a  hard  under  stratum) 
and  has  room  for  free  pressure  movement. 

Sometimes  this  has  to  be  repeated,  and  j^ar- 
ticular  points  especially  warmed,  to  get  the 
trimming  exact.  But  persistence  is  sure  to  bring 
accurate  results. 

"Quick  work!'  Yes,  it  is  quick  work.  And, 
by  the  way,  you  can,  by  this  very  =  edging 
process,  trim  an  impression  (hence  the  plate) 
more  than  ten  times  quicker  than  you  could 
file  '  trim  a  plate,  not  considering  the  incom- 
parably greater  accuracy  in  favor  of  muscle' 
trimming. 

Each  one  of  you  will  liave  to  ])ractice  and 
get  the  move  on  your  own  face,  to  show  your 
patients.  You  can't  merely  tell  all  what  to  do. 
Some  must  be  "shown." 


13) 


34  Greene   Brothers'  Clixical   Course 

Then,  once  in  a  while,  you  nia\'  have  to  train 
a  patient — not  only  to  act,  but  to  act  promptly j 
before  you  attempt  the  practical  action  of  her 
face. 

If  one  attempts  to  joke  and  say  and  do 
funny  things,  just  look  stolid  and  don't  smile, 
but  frown  at  her  "monkeying."  Give  her  to  mi- 
derstand  that  you  are  in  earnest,  and  she  soon 
M'ill  be. 

Until  you  become  familiar  with  this  part  of 
the  work  you  may  have  to  "very'cdge"  one 
side  at  a  time,  always  entering  into  the  mouth 
on  the  opposite  side  from  the  softened  rim. 
This  to  prevent  the  cheek  from  malspressing 
the  softened  edge. 

Be  careful  to  soften  proj)erly  behind  tuber- 
osities. Tliere  the  muscles,  sometimes  stringy, 
will  press  down  onto  the  soft  material  and 
do  their  own  trimming,  without  much,  if  any, 
straining  motion.  In  your  hurry  don't  forget 
this  })oint.  behnid  and  around  the  "heel^knobs." 

TO  ESPECIALLY  FIT  PARTICULAR  MUSCLES. 

As  a  matter  of  importance,  I  '11  here  again 
repeat:  If  anywhere,  at  any  time,  you  should 
see  on  your  partially  "very=edged"  rim  indica- 
tions of  muscle  strain,  just  re* warm  that  par- 
ticular spot  "very  shallow"  at  the  side  of  your 
spirit  flame,  or,  better,  with  a  mouth  blow=pipe, 
and  hurry  it  into  the  mouth  and  have  patient 
work  that  muscle  promptly. 

If  she  is  too  slow,  assist  her  motion  with 
your  fingers.  But  better  first  train  lier  to  her 
own  movement,  whenever  you  can. 

^Vhile  attendhig  to  special  parts,  don't  for- 
get the  upper  freenum.  You  '11  be  surprised 
at  both  the  quickness  and  accuracy  of  results. 
Unless  individual  muscles  need  special  attention. 


IX  Dental  Prosthesis.  35 

you  can  accurately  trim  an  impression  (conse- 
quently the  plate)  in  a  few  seconds. 

Bear  in  mind:  AVhen  you  musclc'trim  a 
rim*edge,  it  is,  with  rare  exceptions,  left  high 
enough  to  reach  beyond  tlie  hard  parts  onto 
the  soft  and  yieldable  tissues.  Only  on  such 
you  can  get  valve^pressure  fits. 

(Here  in  the  class  Course  we  show  the  very* 
edging  process,  in  minute  detail,  on  our  own 
jjractical  plate,  in  our  own  mouth;  altvays  to 
the  gratifying  surprise  of  the  old '  way  file- 
trimmers.  ) 

Someone  asks:  "How  much  should  this  be 
done  in  a  given  case?"  Why,  iust  till  the  or- 
dinary and  natural  movements  of  the  cheek 
and  lips  fail  to  cut  any  deeper  into  the  "very 
softened"  material. 

But,  doctors,  don't  forget  this  "new  thought," 
that  you  've  probably  never  heard  of  before ;  cer- 
tainly never  in  print.  There  are  some  mouths 
where  cheek=and*lip  motion  isn't  sufficient, 
even  when  properly  done.  It  is  sometimes  neces- 
sary to  further  and  additionally  warm  the  im- 
pression down  into  the  groove  that  covers  the 
ridge  and  tuberosities,  from  about  the  second 
bicuspid  back;  and  then  have  patient  bite  down 
onto  your  fingers,  or  her  fingers,  or  on  some  com- 
pound, placed  for  the  purpose  on  the  under-side 
of  the  tray — on  both  sides  at  once. 

This  is  to  provide  in  your  denture  for  strain 
made  by  the  biting  muscles  and  must  be  done  by 
biting  down  instead  of  pressing  up.  But  all  this 
will  come  up  more  plainly  in  our  second  lesson 
when  dealing  Avitli  the  massiter  muscles. 

When  a  plate  is  trimmed  to  stand  tlie  ordi- 
nary movements  of  the  mouth  and  face,  the 
M'earer  will   soon  learn   to  avoid  extraordinary 


36  Greene  Brothers'  Clinical  Course 

ones,  or  even  to  safely  make  them,  in  practical 
use. 

(Fifth  Step.) 

CONFORM  COMPOUND  TO  SOFT  PARTS. 

Your  impression  reaches  up  onto  the  yield- 
able  tissues,  on  which  you  are  to  make  an 
equahzed  valve'pressure  strain  against  the  in- 
ner side  of  the  impression  rim  at  its  top. 

While  the  tissue  reached  is  generally  yield- 
ing, it  may  still  be  harder  in  some  places  than 
at  others;  and  it  is  on  these  different  textures 
you  want  to  equalize  strain.  That  is,  press 
against  the  soft  parts,  between  the  harder  ones, 
so  as  to  get  an  air-tight  fit  on  the  soft  places, 
as  well  as  on  the  harder  ones. 

To  do  tliis,  you  simply,  but  slightly^,  warm 
that  part  of  the  impression  that  is  above  the 
metal  tray,  and  press  gently,  but  firmly,  hori- 
zontally against  these  soft  parts,  and  cool  it 
there  while  under  strain.  I  emphasize:  while 
under  strain;  otherwise  the  material  might  re- 
bound, when  you  'd  lose  j^our  pressure. 

Conforming  is  the  name  we  give  this  right* 
angle'pressuj'e  operation.  While  it  is  very  sim- 
ple, it  requires  nicety  of  manipulation  and  care; 
nicety  to  do  it  and  care  not  to  afterward  undo  it. 

It  requires  more  experience  to  properly  con- 
form the  rim  of  an  impression  to  the  tissues 
than  to  do  any  other  one  thing  I  '11  show  you 
in  this  A\hole  Course  of  eight  to  ten  hours. 

But  I  hope  you  '11  not  object  to  some  nicety 
of  operation  and  carefulness  as  long  as  less  is 
asked  of  you  than  you  require  of  the  man  who 
shaves  you.  Should  you  hesitate  at  simple 
trained  touches  like  this,  then  never  attempt 
the  keener  teclinics  of  tonsorial  artistry. 


IN  Dextal  Prosthesis.  37 

But  let  's  do  it.  AVatch  me  warm  the  rim 
of  this  upper  impression  (on  the  left  side)  by 
passing  it  back  and  forth  over  this  hand^lamp. 
I'm  slowly  warming  it  through  from  the  outer 
side  inwardly;  all  of  it  from  the  metal  tray 
upward. 

I  '11  mildly  warm  it  from  the  front*center 
clear  around  behind  the  tuberositj^  till  it  reaches 
about  the  softness  of  the  palm  of  my  hands. 
I  test  its  yieldance  with  my  finger — it  's  ready! 
I  slip  it  into  the  mouth  and  hold  it  up  with 
the  long  finger  of  my  right  hand,  and  press 
gently  to  the  left  cheek  outside,  with  my  left 
thumb  *  and  -  hand,  clear  around  to  the  front' 
center. 

See?  My  thumb^hand  just  fits  the  madam's 
face  as  if  it  'd  been  made  for  the  purpose.  I 
push  squarely  against  the  cheek  and  on  the 
front  lip,  and  hold  it  so  for  about  a  minute. 
By  that  time  the  Kerr  "Perfection"  material  will 
have  "set"  enough  to  prevent  rebounding  when 
I  remove  my  thumb. 

"Hold  still,  JNIadam;  don't  move  a  muscle!" 
I  reach  over  and  dip  my  left-hand  index  fin- 
ger (clean-cloth=stall5covered)  into  my  near'by 
cold'water  cup  and  hasten  to  reach  in  under 
the  lip  and  cheek  (left  side)  and  cool  my  now* 
conformed  rim  with  a  little  pressure. 

If  I  have  an  assistant,  I  have  lier  do  the 
cooling  with  a  small  syringe.  But  bear  in  mind, 
the  cooling  should  be  done  while  the  pressure 
is  on,  for  fear  of  rebound. 

(We  have  no  long  handles  on  our  trays  to 
be  in  the  way.  Ours  are  either  about  threes 
fourths  of  an  inch  long  horizontally,  or  one* 
fourth  turned  down  perpendicularly;  or  wholly 
removable,  when  no  longer  needed. 


38  Greexe   Brothers'  Clinical  Course 

Next,  conform  the  opposite  side  in  the  same 
way.  But  here  one  special  caution,  doctors: 
after  you  have  conformed  one  side  of  the  im- 
pression, don't  push  it  off  from  its  gum  when 
3''ou  conform  the  opposite  side,  and  by  so  doing- 
make  a  side'slipping  impression.  This  relates 
particularly  to  flat  mouths. 

In  a  big  mouth,  with  tliin  lips,  we  can  con- 
form both  sides,  and  in  front,  too,  all  at  the 
same  time.  Then  there  's  no  danger  of  micon- 
forming  one  side  ^vhile  we  conform  the  opj)osite 
side.  I  sometmies  thus  conform  both  sides  and 
in  front  all  at  the  same  squeeze,  by  clampmg 
the  whole  face  bet\\een  my  thumb  and  index 
finger  of  my  right  hand,  while  I  hold  the  im- 
pression up  to  place  with  my  left  index  finger; 
or  vice  versa. 

The  amount  of  strain  used  in  this  conform- 
ing should  be  about  the  same  as  I  make  by  suck- 
ing my  cheeks  in  firmly.  In  fact,  conforming 
by  cheek  suction  would  be  the  way  if  we  could 
readily  get  our  x^atients  to  do  it. 

Say,  doctors,  when  you  have  conformed  the 
rim  of  an  impression  all  around  to  the  sides 
of  the  alveolar  ridge  properly,  you  have  indeed 
accomplished  a  most  valuable  operation. 

Xow,  we  '11  go  on  and  gently  warm  the  heel= 
corners,  return  it  to  the  mouth  and  hold  it  to 
place  with  our  left-hand  middle  finger,  while 
with  our  right  index  finger,  cloth'covered,  we 
reach  up  behind  the  tuberosities  and  conform 
there  gently,  too.  We  finger  under  and  around 
by  way  of  the  palate  usually,  but  sometimes 
via  the  more  cramped  cheek  passage. 

It  is  all  =  important,  especially  in  cases  of 
roofless  plates,  that  dentures  fit  up  snugly,  xicith- 
out  undue  pressure,  around  these  prominences. 
It  is  essential  to  roofless  plates. 


IX   Dextal   Prosthesis.  39 

We  sometimes  have  sueli=like  conformation 
made  by  the  i)atients  tongue,  cooling  it  well 
before  removal,  after  held  to  place  to  set  a  minute 
or  so. 

It  is  fine  work  to  properly  fit  a  plate  aromid 
tuberosities ;  but  when  done,  it  ^von't  easily  tip 
down  behind  when  bitten-on  in  front.  Xow 
clinch  this  heel=knob  ])ointer  in  vom-  minds : 

Xow,  doctors,  in  practice  we  can  frequently 
make  all  these  steps,  so  far  shown,  by  joining 
them. 

Xo  language  can  ovev'praise  the  results  of 
proper  conformation  of  the  rim  of  a  plate  to  the 
yielding  tissues! 

(Sixth  Step.) 

CONFORM    ("POST-DAM")    BACK  PALATE. 

Xow  all  parts  of  our  correctable  impression 
have  been  fitted  to  the  parts,  excepting  the 
back  palate.  As  this  is  really  the  most  import- 
ant point  for  adjustment  in  the  whole  mouth, 
I  have  left  it  till  the  last. 

The  im])ression  material  purposely  reaches, 
as  you  understand,  a  little  back  beyond  the 
metal  tray;  so  the  shortness  of  the  metal  gives 
room  for  a  little  cut-out  of  material  under  the 
end  of  the  impression,  leaving  it  thin=like  there, 
similar  to  the  rim. 

Xow,  let  us  slightly  warm  this  over'projec- 
tion,  as  we  did  that  above  the  metal  rim,  so 
we  can  conform  it  to  the  yieldable  tissues,  onto 
which  it  reaches. 

I  instruct  my  |)atient:  "Xow,  Madam,  when 
I  put  this  impression  into  your  mouth,  I  want 
you  to  press  it  up  gently,  but  rather  firmly,  at 
the  back  ])art,  with  your  tongue,  and  liold  it 
there  a  minute  till   I  snap  my  finger.  "     When 


40  Greene  Brothers'  Clinical  Course 

"set"  enough  to  not  yield  back,  she  drops  hei 
tongue;  and  I  finish  with  cold^finger  pressure, 
same  as  I  did  the  upper  rim. 

The  tongue  being  soft,  it  presses  the  soft 
material  against  the  soft,  j^ieldable  tissue  to 
exactness.  If  there  are  any  granular  or  hard 
spots  back  there,  as  often  there  are,  the  ])ves- 
sure  equalizes  the  strain  against  them  and  be- 
tween them. 

There  is  now  a  little  general  up^push  all 
along  the  yielding  line;  a  little  valveslike  press- 
ure that  precludes  air  passage  under  it. 

Study  well  the  rules  and  practice  the  meth- 
ods of  fmding  this  exact  right  reach  of  your 
plate.     (Index  L.) 

Method  A,  by  tongue  pressure,  is  the  way 
I  've  shown  you  to  conform  a  modeling'com- 
pound  impression  to  the  post'palate. 

It  is  mj^  preferable  way,  and  my  general 
way  Lmder  favorable  conditions.  But  some- 
times we  have  deaf  people  and  sometimes  non- 
Enghsh^speaking  people  to  deal  with.  (Some- 
one says:  "Yes,  and  dam-phools !" )  Well,  we 
must  have  a  way  to  post'dam,  in  such  cases, 
without  the  patient's  help. 

Method  B,  by  roof  pressure.  This  we  do 
by  warming  the  rear  of  the  impression,  as  in 
Method  A,  and  then  turning  it  up  a  little  too 
high  and  pressing  it  up  against  the  roof  of  the 
mouth,  when  the  tissues  will  push  it  back,  still 
leaving  some  valve^like  pressure.  Of  course, 
we  cool  as  before. 

While  Method  B  isn't  quite  as  accurate  as 
Method  A,  it  is  far  more  so  than  any  of  the  old 
scraping  and  grooving  ways  of  getting  rear 
j^ressure.  Indeed,  in  many  cases  of  granular 
palates,  scraping  and  grooving  for  rear  pressure 


IX   Dextal   Prosthesis.  41 

won't  do  at  all.  Guess-work  is  rarely  exactly  cor- 
rect at  the  best. 

Method  C  is  the  third  way  of  postsdamming; 
that  is  by  finger  pressure.  We  warm  as  before, 
but  scarcely  as  soft  as  in  A  and  B,  and  press 
it  up  and  cool  it  with  clear-cloth'Covered  in- 
dex digit  of  right  hand,  at  the  same  time  holding 
impression  to  place  with  the  long  finger  of  the 
left  hand. 

AVith  experience  and  carefulness.  Method  C 
is  easily  accomplished  and  will  succeed  fairly 
well  when  there  are  no  granules,  or  bumps, 
under  the  mucous  membrane,  to  contend  with.* 
But  in  no  case  does  it  compare  in  exactness 
with  ^Method  A,  by  tongue  pressure. 

Bear  in  mind,  that  in  any  way  the  cooling 
must  be  done  while  the  little  j^ressure  is  on. 

THE  ESSENTIAL  ART  IN  HANDLING  MODELING 
COMPOUND 

is  to  keep  it  cool   after  it  has  been  adjusted; 
and  to  warm  one  part  and  adjust    it    without 
disturbing   it   elsewhere.     But   the    work  is   no 
more  difficult  than  many  other  things  a  dentist 
has  to  do. 

AN'^hile  it  requires  far  more  skill  to  take  a 
modeling-compound  impression  rightly  than  one 
in  all-plaster,  the  results  amply  pay  for  it,  and 
many  times  over. 

In  the  details  of  a  single  impression  we  do 
several  different  things,  even  though  we  do 
them  all  at  once  in  combination. 

Now  every  one  of  these  details  can  be  done 
— ^^at  least,  wath  tliis  material  (Kerr's  "Perfec- 
tion)"; while  not  near  all  of  them  can  be  done 
with  plaster.  But  the  whole  plastersunpression 
subject  is  to  come  up  later  on. 


42  Greexe   Brothers'  Clinical   Course 

UNITING  DETAILS. 

Ipx  actual  practice  we  unite  as  many  of  these 
details  as  the  case  will  warrant.  Sometimes  we 
can  verv'edge  the  rim  all  around  at  once;  in 
large  mouths  with  thm  lips,  for  instance. 

And  then,  again,  as  already  shown,  we  can 
sometimes  conform  all  around  at  once,  even  in- 
cluding tuberosities. 

And  frequently  we  can  both  very-edge  and 
conform  all  at  the  same  step — perhaps  not  al- 
ways perfectly,  but  yet  to  stand  the  tests  fairly 
well. 

Sometimes — in  fact,  often — we  conform  be- 
hind tuberosities  and  post'dam  at  the  back  pal- 
ate at  the  same  time.  It  's  a  quick  and  easy 
way.  ^ 

Sometimes  the  center  can  be  equalized  with 
hotsstream  (seldom  necessary)  and  wave^press- 
ure  at  the  same  step  when  the  very*edging  is 
done.  And  it  's  possible  for  an  expert  to  do 
all  these  things  thoroughly  by  two  trijis  into 
the  mouth;  and  fau'ly  well  by  a  single  trip. 

But  trips  into  the  mouth  don't  mean  by 
the  Greene  methods  what  they  do  by  the  old 
ways,  by  any  means.  Our  metal  trays  are  not 
as  deep  nor  as  long  as  our  finished  plates  are 
to  be,  as  j^ou  have  seen.  And  our  impressions, 
even  from  the  first,  contain  so  little  bulk  that 
patients  are  always  agreeably  suri^rised,  after 
having  heard  so  much  about  the  horrors  of 
impression^taking;  and  tliey  almost  invariably 
so  express  themselves — voluntarily,  too. 

And  for  this  one  reason  it  pays  to  use  the 
student's  method  of  fitting  a  tray  to  an  ap- 
proximate model  and  taking  the  correctable 
impression  from  this  model.     (Index  L.) 

Bear  in  mind,  we  use  no  common,  deep 
trays,  even  in  taking   an    approximate    impres- 


IX   Dental   Prosthesis.  43 

sion;    and    seldom    one-fifth    as   much    material 
as  hy  the  old  methods. 

TEST  THE  COMPLETED  IMPRESSION. 

Now,  after  post  =  dammmg  (Index  P),  we 
make  tlie  final  test.  We  slip  the  impression 
back  into  the  moutli  and  have  patient  open 
and  close,  laugh,  bite  her  finger,  and  swallow. 
If  none  of  these  movements  throws  the  impres- 
sion down,  they  11  not  throw  down  a  plate  prop- 
erly made  from  it;  for  the  latter  will  be  a  mold- 
ed duplicate  from  the  former. 

Conversely,  if  any  movement  should  loosen 
the  imjiression,  it  would  do  the  same  to  the 
plate.  So  you  'd  know  one  or  the  other  in 
advance. 

Really  you  '11  seldom  find  it  necessary  to 
make  any  correction  after  you  've  made  these 
six  steps  in  detail.  But,  for  convenience  of  il- 
lustration, we  '11  suppose  you  make  a  blunder 
in  your  first  attempt  at  a  test  impression.  Af- 
ter you  have  post-dammed,  you  make  your  test. 
You  2^ush  your  impression  up,  and  it  drops 
down,  even  without  any  lip,  or  cheek,  or  swal- 
lowing motion  at  all. 

STOP,  THINK  AND  REASON. 

After  you  got  the  length  of  the  impression 
and  then  tested  for  roof^fit,  you  found  it  stuck 
up.  After  you  muscle'tnmmed  and  conformed 
its  rim,  it  stuck  still  tighter.  But  now,  after 
you  post^dammed  its  rear  end,  it  drops.  What 's 
the  matter? 

The  case  is  very  plain.  You  over-strained 
the  palate  in  post-damming.  The  over-strained 
parts  rebound  and  push  the  impression  off. 
What  's  the  remedy?  Common  sense — just 
?ni*post-dam  it,  and  do  it  over. 


li  Greene   Brothers'  Clinical  Course 

That  is,  warm  it  as  in  the  first  place,  and 
post^'dam  again;  but  ne.vt  time  with  less  strain. 
Keep  on  till  you  get  a  stick=up  test. 

Don't  object  to  doing  this  three^minute  job 
over,  for  the  alternative  would  be  to  make  the 
j)late  from  it  "over" — ^^maj^be  several  times. 
(Someone  says:   "We  're  used  to  that.") 

Well,  3^ou  've  re'j^ost'dammed  and  have  a 
test ;  but  only  a  still  test.  It  stays  there  all  right 
when  no  muscles  move.  Now  give  it  another 
test.     Have  your  patient  swallow  vigorously. 

IF  IT  "SWALLOWS  DOWN." 

]My,  how  swallowing  throvvs  it  down!  What  's 
the  matter  notv?  It  either  reaches  too  far  back 
or  else  some  small  palatal  muscle  (one  or  more) 
reaches  unusually  forward.  In  rare  cases  such 
may  reach  quite  a  way  forward. 

In  this  case,  you  will  first  re-test  for  length. 
Maybe  you  missed  it  a  Httle  in  getting  proper 
length  in  Step  Two. 

If  you  find  your  impression  isn't  too  long, 
then  try  for  palatal  muscular  strain.  That  is, 
warm  the  top  of  the  impression  at  the  very 
back  part,  place  it  in  the  mouth,  and  hold  to 
place,  while  patient  bites  on  your  finger  and 
swallows  vigorously.  She  can't  well  swallow 
without  biting  on  something. 

The  moving  muscle  will  strain  down  the 
softened  material;  and  thus  a  single  ett'ort  may 
cure  the  trouble.  But  make  as  many  efforts 
as  are  necessary;  then,  of  course,  re^post^dam 
slightly  and  cool  well  before  removal,  as  before. 

Take  Xotice:  After  you  find  the  slight 
indentation  in  your  impression  made  by  the 
swallowing  test,  you  can  use  the  mouth  blow* 
pipe,  as  in  special  very*edging  for  muscle  room 
on  the  rim,  a  while  ago. 


IX  Dental  Prosthesis.  45 

ABOUT  NAUSEA. 

Xever  cut  oif  a  plate  in  front  of  the  valve* 
i^ressure  line  to  prevent  nausea.  Even  if  it 
cured  the  "gagging,"  it  would  make  an  easy- 
tipping  plate.  But  shortening  alone  might  not 
cure  the  gagging. 

Nausea  is  often  caused  by  lack  of  pressure 
at  the  rear  of  the  plate.  Propersfitting  (valve- 
pressure)  plates  can  be  worn  farther  back  than 
poorly  fitting  shorter  ones  can  be. 

But  nausea  is  often  from  a  mental  delusion, 
and  then  must  be  cured  by  a  process  of  "men- 
tal suggestion."  If  a  patient  falsely  thought  a 
bed-bug  w^as  imder  her  dental  plate,  she  would 
"gag."  And  similarly,  if  she  thought  the  plate 
Mas  too  long  when  it  was  not  so. 

I  have,  as  others  have,  cured  scores  of  cases 
of  nausea  by  appropriate  means  of  suggestion. 
It  has  often  been  done  by  pretending  to  shorten 
the  plate  "just  a  leetle  bit"  without  doing  so. 
And  all  experienced  dentists  will  tell  you  of 
cases  where  they  cured  nausea  by  treating  the 
patient's  will-power.  Teach  them  how  to  ap- 
ply auto  -  suggestion.  (Every  dental  college 
should  be  supplied  with  a  "chair"  filled  with 
an  expert  instructor  in  Scientific  Suggestion.) 

AVhen  the  cause  of  nausea  is  physical,  or 
material,  then  combine  physical  and  mental 
medicine.  Benumb  Mith  cocaine  and  '"tan" 
\\'ith  oak^bark  tea,  or  any  other  astringent. 
But  always  mix  in  good  Suggestion. 

MAKE  MODEL  ON  TESTED  IMPRESSION. 

Our  impression  now  stands  the  actual  test; 
we  must  "pour"  oin-  model  before  it  changes. 
Unless  we  can  fill  it  right  away,  we  must  keep 
it  in  cold  water  until  we  can  use  it.     Bear  in 


46 


Greene   Brothers'  Clinical  Course 


Fig.  k 


Fig.  5. 


Fig.  4 — Modeling  comiiound  impression  as  usually  taken  in 
common  deep  tray.  Plate  would  have  to  be  guess-trimmed  to  fit 
straining  muscles — difficult  if  possible. 

Fig.  5. — In  the  same  tray  cut  down  and  fitted  to  the  mouth. 
Test  impression  just  as  taken  liy  the  Green  muscle-trimming 
method.     No  trimming  of  plate  after  made. 


Fig.  6. 

Modeling  copound  tested  inijiression,  jubt  as  taken;  for 
plumping  out  tlie  features.  Common  deep  tray  cut  down  for  the 
purpose. 


IN   Dental   Prosthesis.  47 

mind  that  even  this  "Perfection"  material  will 
warp  some  in  a  warm  room.  So  impressions 
of  modeling  componnd  must  be  kept  cool  mitil 
filled;  rememher  that.  Better  underscore  this 
with  red  pencil. 

Before  we  pour  our  plaster,  we  '11  thin  our 
rim  down  to  the  exact  thickness  we  want  our 
plate.  We  do  it  with  our  sharp  x^ocket^knife. 
If,  however,  we  want  the  patient^s  face  built 
out,  we  leave  the  rim  thick,  or  even  add  to  it 
(carefully)  by  tracing'On  more  from  our  blessed 
tracing=sticks. 

Then,  also,  before  we  "pour,"  we  11  polish 
the  rim^edge  by  quickly  passing  it  a  very  few 
times  over  our  little  spirit  flame  and  blowing 
onto  it  quickly  from  our  mouth.  But  be  care- 
ful not  to  heat  it,  in  the  least,  to  any  depth. 
Cool  between  each  blowing  and  don't  keep  at  it 
too  long. 

The  edge  is  now  polished,  and  ten  to  twenty 
times  quicker  than  tlie  rim  of  the  plate  could 
have  been  j^olished  after  vulcanized.  The  com- 
ing plate's  rim  will  now  need  the  least  touch 
of  the  polishing=wheel  to  com])lete  it. 

Again,  before  \ve  pour,  we  must  see  that 
our  im])ression  is  dri/.  If  wet,  the  face  or  our 
model  may  come  out  soft,  from  lack  of  ])roper 
crystallization;  that  is,  from  too  much  water 
for  the  amount  of  plaster.  We  can  soap*lather 
our  impression  thinly,  or  dust  it  with  soa])' 
stone  powder,  but  mc  don't  xcet  it.  It  must 
have  no  visible  water  in  it. 

I  know  this  is  contrary  to  high  authority, 
but  I  insist  on  no  water  in  my  impression  when 
I  make  a  model.  And  I  advise  you  to  make 
some  tests  along  this  line;  then  report  to  your 
old  instructors,  who  advised  wet  im])ression. 


48  Greene   Brothers'  Clinical   Course 

Within  a  stretch  of  four  years,  I  asked  two 
hundred  and  fifty  some  dentists  what  made  their 
models  sometimes  come  out  of  the  impressions 
with  soft,  dusty  surfaces;  and  just  twelve  an- 
swered me  correctly  — =  under  '  saturation  and 
faulty  crystallization. 

Of  course,  such  a  model  would  be  unfit  to 
vulcanize  on.  And  yet  how  many  plate^makers 
fail  to  comprehend  this  self-evident  fact! 

HOW  TO  MAKE  THE  MODEL. 

Now,  mix  your  plaster  by  the  "fullssatura- 
tion"  method.  First  put  the  needed  amount 
of  water  in  a  clean,  smooth,  earthen  bowl  and 
then  put  the  plaster  in  it.  Don't  "sift  it  in 
slowly,"  for  some  of  it  ^vould  be  wet  much 
longer  than  the  rest.  But  dump  it  in  hurriedly; 
then  hack  it  up-and-down  with  your  spatula 
till  it  is  wet  through.  Then  mix  quickly  and 
"pour"  before  it  begins  to  set  at  all.  Always 
tap  howl  and  pour  of  all  the  water  you  can. 
Then  pepper*box  a  little  on  top  to  satisfy  the 
watery  surface,  if  needs  be. 

If  you  stir  it  after  it  begins  to  set  much, 
you  '11  violate  chemical  action,  break-up  the 
forming  crystals  and  make  an  imperfect  body; 
which,  though  hard  to  cutj  softens  readily  under 
heat  and  pressure.  So,  see  that  as  far  as  pos- 
sible all  crystallization  ("setting")  takes  place 
after  the  piaster  is  in  the  impression;  especially 
the  first  part  of  it. 

Extend  the  plaster  just  a  little  beyond  the 
rim  of  the  impression  all  around,  and  don't 
make  the  model  needlessly  thick  over  the  arch. 
Reason  for  this  later  on. 

Now,  after  the  plaster  in  the  impression  is 
well  set,  trim  it  (plaster)  off  all  arovmd  down 
even  with  the  compound,  using  the  impression 


IX   Dental   Prosthesis.  49 

itself  as  the  guide  to  your  thin-ground,  sharp 
knife.  Hold  your  knife-blade  at  proper  angle 
so  as  not  to  cut  over  into  the  bench,  or  shoulder 
of  the  model;  which  extension  is  to  form  the 
edgesrim  of  the  plate. 

TO  SEPARATE   MODEL   FROM  IMPRESSION. 

First  warm  the  metal  tray  and  pull  it  off. 
Then  set  the  impression  into  fairly  Avarm  ^vater, 
just  deep  enough  to  cover  the  impression  ma- 
terial, and  not  to  warm  the  model. 

Then  turn  the  warmed  compound  down  at 
one  of  the  heel-corners  to  get  hold,  and  peel 
the  w  hole  impression  off  from  the  model. 

You  now  have  a  good,  hard^surfaced  model, 
with  a  smooth  bench;  which  extension  is  to 
give  the  plate  the  exact  same  height  and  thick- 
ness of  rim  the  impression  had.  Plaster  should 
be  "well  stirred,"  but  the  least  bit,  if  any  at 
all,  after  it  begins  to  set. 

As  for  myself,  I  like  to  polish  the  roof  of 
my  impression,  same  as  the  rim,  so  that  part 
of  my  plate,  too,  will  be  smooth  and  easily 
kept  clean  in  w'earing.  15ut  should  you  do  this, 
be  sure  and  test  for  fit  again  before  you  pour 
your  model.  At  first  you  '11  be  sure  to  use  too 
mucli  heat  in  ])olishing  your  impression;  for 
any  heat  is  too  much.  And  you  '11  be  apt  to 
continue  the  gloss-warming  and  blowing  too 
long. 

DON'T  LET  IMPRESSIONS  CHANGE. 

Make  your  model  at  once,  before  the  Impres- 
sion warjjs  from  the  lie  at  of  yonr  room.  Or  else 
put  it  in  cold  water,  and  keep  it  in  until  you 
get  time  to  use  it.  Doctors,  this  repetition 
needs  no  apology.  You  've  probably  been  let- 
ting impressions  change  before  filling. 

[4] 


50  Greene  Brothers'  Clinical  Course 

The  absolute  unreliability  of  the  average 
"brand"  of  modeling  compound  in  holding  its 
shape,  and  the  ignorance  concerning  its  man- 
ipulation, and  the  carelessness  of  dentists  are 
the  principal  three  reasons  why  compound  is 
not  in  universal  use  for  impression^taking ;  es- 
pecially for  full  plates. 

METAL   vs.   PLASTER  MODELS. 

Now  as  to  the  question  of  models.  I  've 
given  you  what  I  conceive  to  be  the  best  meth- 
od of  making  plaster  models;  that  is,  full  sat- 
tiration,  with  no  stirring  after  hardening  begins; 
the  same  holding  true  of  the  various  mixtures 
of  plaster,  sand,  Portland  cement,  etc.,  etc. 

If  you  use  good  plaster  and  this  carefulness 
in  mixing,  and  don't  spoil  your  models,  nor 
pack  so  as  to  strain  them  any  after  they  be- 
gin to  soften  (by  natural  disintegration,  that 
takes  place  under  heat  and  moisture  at  about 
300  degrees  F.),  you  may  get  through  your 
case  without  much  change  in  your  model. 

But  under  the  greatest  skill  in  mixing  and 
pouring  and  flasking  you  will  always  have  sonie 
change;  possibly,  however,  in  a  direction  to  do 
more  good  than  harm,  as  to  that. 

Under  conditions,  plaster  will  expand  and 
contract;  and  its  compressibility  is  sometimes 
astonishing. 

To  prove  this  yourself,  make  you  two  plas- 
ter models  from  the  same  impression.  Then 
vulcanize  on  one  of  them  and  try  yoiu-  plate 
on  the  other  one.  There  will  always  be  some 
lack  of  fit,  which  shows  just  what  change  took 
place  in  the  model  you  vulcanized  on  under 
moisture,  heat,  and  pressure,  including  the  force 
of  ^ailcanite  shrinkage  by  hurried  cooling. 


IN  Dental  Prosthesis.  51 

So  the  less  pressure  j'ou  apj^ly  in  packing 
(especially  after  your  model  begins  to  soften) 
and  the  more  slowl}^  j^ou  cool  a  flask,  the  safer 
you  are  from  serious  change. 

And  now,  to  fully  imx^ress  j^ou  with  the  com- 
pressibility of  plaster,  you  can  easily  make  a 
convincing  test  for  yourselves.  Prepare  a  flask, 
both  halves  filled  with  the  best  plaster;  place 
a  silver  dollar  between  the  two  halves  and  boil, 
and  squeeze,  and  vulcanize  as  usual.  Then 
open  it;  you  '11  find  your  silver  dollar  entirely 
hidden  in  the  plaster.  Then  use  tivo  dollars, 
one  on  the  other,  and  record  your  impromptu 
ejaculations.  (I  made  this  exposure  of  the 
faultiness  of  plaster  at  the  National  meeting 
at  Birmingham  in  1909.) 

GREENE'S  NON^CHANGEABLE  MODEL  SYSTEM. 

But  I  'm  glad  to  report  to  the  dental  pro- 
fession that,  after  years  of  puzzling  over  the 
A'^xatious  question,  I  liave  at  last  solved  the 
problem.  The  problem  of  avoiding  tliis  inev- 
itable change  in  j^laster  models,  both  before 
and  during  the  flashing  and  \Tilcanizmg  j)rocess 
and  in  hurried  cooling. 

I  do  it  by  disposing  of  95  per  cent  of  the 
amount  of  plaster  in  a  model,  to  begin  with; 
and  then  holding  the  5  per  cent  into  place 
so  the  infinitesimal  change  in  it  can't  do  any 
perceptible  harm. 

I  make  an  approximate  model  of  aluminum 
with  its  surface  prepared  to  retain  a  thin  film 
of  plaster. 

Tliis  aluminum  model  is  of  a  size  and  shape 
to  slip  down  into  and  approximately  fit,  but 
still  very  loosely  fit,  the  impression.  In  fitting 
this  non-changeable  metal  model  to  the  impres- 
sion, I  first  besmear  its  face^surface  with  a  little 


52  Greene  Brothers'  Clinical  Course 

plaster;  then  dip^jjour  some  into  the  impres- 
sion and  plunge  the  face=covered  metal  model 
into  it;  then  hurry  up  and  complete,  the  same 
as  if  the  model  were  all  plaster. 

I  then  trim  the  model  A\hile  yet  in  the  im- 
pression;  and  also  remove  the  impression  ma- 
terial from  it — both  just  the  same  as  with  the 
all-plaster  one  before  mentioned. 

Xow  we  have  a  metal  model,  thinly  ve- 
neered with  plaster;  which  facing  is  necessary 
to  fit  it  to  the  impression,  and  also  to  enable 
the  removal  of  the  metal  model  from  the  vul- 
canized plate.  But  the  amount  of  plaster  used 
is  too  small  for  any  proportionate  change  in  it 
to  be  noticeable. 

I  may  here  add  that  in  some  cases  of  under* 
cuts  in  the  mouth  the  case  must  be  left  in  the 
flask  till  the  softening  takes  place  in  the  plas- 
ter coating  on  the  metal  model.  Leave  the 
case  in  flask,  if  convenient,  over  night;  in  fact^ 
that  's  the  right  thing  to  do  in  vulcanite  work 
anyhow. 

But,  instead  of  making  an  approximate  mod- 
el for  each  case,  I  have  a  set  of  them  already 
made,  from  which  I  select  the  one  needed.  It 
consists  of  one  hundred  models  and  is  expected 
to  accommodate  almost  any  case,  full  or  partial. 

The  set  is  so  systematized  in  size,  shape^ 
number,  and  letters  that  one  or  two  minutes 
is  sufficient  time  for  making  the  selection. 

For  swaging  (by  the  new^process  methods 
only),  we  veneer  our  metal  mold  with  a  half- 
and-half  mixture  of  Portland  cement  and  plas- 
ter, well  pulverized  together  in  a  mortar  before 
wetting.  This  swage  -  model  must  thoroughly 
harden  l)efore  use. 

(Here  the  class  is  shown  how  to  fit  Greene's 
nonschangeable,   approximate   metal   models   to 


IX   Dental   Prosthesis.  53 

an  impression.  See  especial  instruction  in  Ap- 
pendix hereto;  under  heading:  The  Greene 
Ready  ^Xade  Xox^CHxiXGEABLE  Approximate 
Models. 

modeling=compound  impressions  in  difficult 

CASES. 

Our  instructions  so  far  apply  to  ordinary 
cases.  But  occasionally  we  find  mouths  where 
other  different  means  must  be  used.  For  in- 
stance, here  we  have  a  case  with  protruding 
ridge  in  front  and  an  "underscut"  above  it. 

To  take  this  impression  and  preserve  the 
under-cut,  we  first  take  it  fully  up  to  the  be- 
ginning of  the  turn  that  makes  the  imder^cut. 
Then  we  trim  this  edge  of  the  impression  down 
so  as  to  dispose  of  all  of  the  under-cut. 

Now  cut  two  or  three  little  notches  in  the 
trimmed^off  edge.  Then  varnish  tliis  edge  and 
brush  a  thickness  of  tm^foil  onto  it.  The  var- 
nish is  to  hold  the  tin^foil  onto  the  trinmied 
edge  of  the  impression. 

Now  we  use  the  "Perfection"  tracing-sticks 
and  trace-on  enough  material  to  bring  the  rim 
up  to  its  proper  height.  Then  warm  the  traced* 
on  addition  over  the  spirit4amp  and  quickly 
slij)  the  impression  into  the  mouth,  and  very- 
edge  and  conform  this  addition  down  onto  the 
main  part  just  as  if  the  two  were  all  one  piece. 
Tliej^  cool  well  and  remove. 

In  taking  it  out  of  the  mouth,  the  addition 
will  pull  loose  from  tlie  main  body  of  the  rim, 
and  the  impression  come  out  in  two  pieces. 

Then,  when  out  of  the  mouth,  we  place  the 
addition  back  onto  the  impression  where  it  be- 
longs, guided  by  the  notches,  and  we  have  our 
full  impression,  under-cut  and  all. 


54  Greene  Brothers'  Clinical  Course 

Should  j'ou  wisli  to  take  an  impression  some- 
what over  a  bulging  tuberosity,  you  can  use 
plaster  for  the  addition,  if  not  too  thinly  mixed. 

Of  course  you  understand  the  tin^foil  is  used 
merely  as  a  sej^arator  between  the  impression 
and  the  added  edge  over  it. 

If  you  take  more  of  the  underwent  than  you 
can  use,  of  course  3'ou  '11  have  to  tip  the  plate 
accordingly  to  enter  it  over  the  bulge.  Prac- 
tically, it  's  no  use  to  take  more  of  an  under- 
cut than  can  be  comfortably  used. 

SOFT,  FLABBY,   ALVEOLAR  RIDGE  WITH 
HARD  ROOF. 

Such  is  about  the  worst  case  you  "11  c\'er 
have  to  deal  with.  The  ridge  hangs  down  loose- 
ly and  flips  to  and  fro  as  j^oui'  lip  does  when 
you  talk. 

The  right  thing  to  do  is  to  absorb  this  flabby 
tissue  ojfj  and  reach  a  harder  density. 

This  can  be  done,  if  patient  can  be  controlled^ 
^^'ith  perseverance  and  patience.  I  have  had 
usually  good  results  from  quarter  strength  iodine, 
with,  say,  two  per  cent  of  it  carbohc  acid. 

It  is  applied  on  bibulous  paper  worn  on  a 
temporary  plate.  One  of  shellac  base^plate  will 
generally  do. 

In  connection  with  the  medicine,  liberal  fric- 
tion should  be  applied  several  times  a  day, 
preferably  with  dry  woolen  cloth.  The  iodine, 
the  friction,  and  the  pressure  together  should 
complete  absorption  in  two  or  three  months. 

But  I  '11  give  you  two  recipes  that  are  prob- 
ably better;  or,  at  least,  quicker.  They  were 
given  me  personally  by  my  esteemed  friend, 
the  world^known  orthodontist,  Dr.  E.  A.  Bogue, 
of  New  York  city— 63  W.  48th  Street. 


IX   Dextal   Prosthesis.  55 

"RECIPE  NO.  1, 

''Vienna  Paste  for  Reducing  Soft  Gums. 
[Translated.] 

"Caustic  Potash,  50  granmies. 

"Quicklime,  60  grammes. 

"Pulverize  the  two  substances  in  a  heated 
mortar;  mix  them  rapidly  and  thoroughly,  and 
put  them  into  a  wide^mouthed  bottle  with 
ground  glass'stopper. 

"We  make  a  soft  paste,  dissolve  with  a  lit- 
tle alcohol  and  apply  in  the  same  way  as  caustic 
potash. 

"Leave  the  caustic  twenty  minutes  or  more 
in  place,  if  a  small  quantity  of  the  paste  has 
been  used  to  make  a  deep  opening.  Wash  the 
eschar  wWh  acidulated  water  to  neutralize  the 
remnants  of  the  caustic. 

"To  lessen  the  pain  caused  by  Vienna  Paste, 
Dr.  Piedagnel  added  a  quarter  of  a  granmie  of 
hydrochlorate  of  morphine. 

"To  make  sure  of  the  action  of  Vienna  Paste, 
'Dr.  Dannecy  dissolved  the  potash  and  lime  in 
an  iron  spoon. 

"Vienna  Paste  melted  in  a  sjjoon,  or  poured 
into  a  leaden  cylinder,  is  a  caustic  which  destroys 
quickly  and  deeply." 

"RECIPE  NO.  2. 

"Dr.  Sass's  Formula  for  Reducing  Soft  Gums. 

^^lODIDE  OF  ZINC. 

"Zinc  Sulphate,  as  much  as  will  dissolve  in 
cold  water. 

"Dissolve  one  ounce  Iodide  Potasli  in  two 
ounces  water,  and  add  as  much  Iodine  in  crys- 
tals at  it  will  take  up. 


56  Greene   Brothers'  Clinical  Course 

"Then  take  equal  parts  of  above  solution 
and  put  them  together.'" 

Iv'e  laiown  dentists  heroieally  to  use  a  pair 
of  curved  scissors.  But  here  in  this  lesson  we  '11 
go  on  and  do  the  best  we  can  without  removal 
of  tissues.  We  '11  compress  it  to  a  degree  of 
equalization  of  stress  between  it  and  the  hard 
roof.  We'll  just  take  the  impression  as  here- 
tofore shown  in  a  plain,  easy  case. 

Of  course,  the  flabby  tissue  turns  outward, 
as  our  lip  does  when  we  push  it  with  our  tongue ; 
but  we  '11  push  it  back  again.  The  metal  tray, 
in  such  cases,  must  be  quite  loic,  so  as  not  to 
interfere  with  such  back^pushing. 

Now,  while  the  impression  is  still  soft,  we 
finger'push  onto  the  outer  rim  until  the  soft 
gum  tissue  behind  it  is  back  to  about  its  normal 
hanging;  then  chill  well  and  remove  it. 

Next  we  hot*stream  the  impression  from  our 
spout*cup  till  its  bottom  surface  (not  to  rim* 
top)  is  quite  soft;  and  re  '  take  with  wave= 
pressure. 

This  time  the  cooled  outer  rim  of  imj^res- 
sion,  being  hard,  prevents  the  flabby  flesh  from 
turning  outward  as  it  did  before. 

Our  upward  wave^motion  strains  the  mushy 
flesh  and  causes  it  to  compress  and  consolidate 
onto  itself;  that  is,  becomes  more  dense. 

We  repeat  this  several  times  if  necessary, 
until  ^^e  get  tlie  flabliy  tissue  almost  to  a  strain- 
ing or  rebomiding  density;  that  is,  till  the  im- 
pression fits  the  soft  ridge  and  harder  roof  with 
approximate  equality  of  stress — ^not  what  we  'd 
ti:ish^  yet  approximately  so. 

Next  w^e  warm  the  impression's  rim^edge, 
hold  it  up  close  and  very*edge,  as  instructed 
before,  in  musclestrimming.     (Index  V.) 


IX   Dental   Prosthesis.  57 

Then  we  re* warm  rim  (outer  side)  from  metal 
tray  to  top,  return  to  the  mouth,  and  conform^ 
according  to  instructions  for  conforming  here* 
before  given.     (Index  C.) 

And  lastly,  we  11  determine  the  length  rear- 
ward, and  post*dam  according  to  density  of  back 
j)alate,  as  you  've  been  carefully  shown. 

And  now  for  test  for  "sticktion."  We  ought 
to  have  an  impression  that  will  not  readily  be 
thrown  down.  It  may  rock,  if  pressed  on  in 
front  or  on  sides,  but,  while  it  gives  upw^ard  on 
one  side,  it  gi\es  downward  oppositely.  Our 
valvespressure*fit  all  around  saves  it  from  tip- 
ping entirely  loose. 

While  such  a  fit  isn't  fully  satisfactory,  a 
plate  from  it  can  be  ^^•orn  with  considerable 
comfort  and  practical  utility.  This  depends 
much  on  the  persistency  of  the  wearer.  I  've 
known  several  plates  to  rock  an  eighth  of  an 
inch  and  yet  worn  with  satisfaction.  I  mean 
in  these  cases  of  flabby  ridges.  The  "play"  of 
the  valve^pressure  kept  them  from  leaking  and 
tipping  loose. 

FLABBY  IN  FRONT  AND  HARD  ON  THE  SIDES. 

Another  case  of  flabby  gum  is,  say,  Avhere 
the  tissue  in  front  is  soft,  while  the  side  ridges 
are  hard.  In  this  case,  we  take  our  correctable 
impression  as  if  it  were  flabby  all  around.  This 
turns  the  soft  gum  outward.  Then,  while  the 
compound  is  still  soft,  ])ush  it  back  (in  front) 
until  the  soft  ridge  is  to  its  normal  perpendicular 
position;  and  cool  before  removal. 

Then  take  it  (impression)  out  and  use  the 
hot*stream  once  or  twice  all  over  the  inner  sur- 
face, each  time  re*fitting  it  to  the  mouth. 

Sometimes  in  equalizing,  in  these  local  spon- 
gy cases,  it  will  be  necessary  to  soften  only  the 


58  Greexe  Brothers'  Clinical  Course 

impression  over  the  hard  tissues,  ui  order  that 
these  rigid  parts  may  cut  down  into  the  soft- 
ened material,  while  the  soft  tissues  are  being 
pressed  up  by  that  part  of  the  compound  that 
is  not  soft. 

To  heat  one  part  of  the  impression  and  not 
the  other  part  is  very  simple:  Just  pack  cot- 
ton over  the  part  not  to  be  heated,  before  pour- 
ing the  hot^stream;  then  immediately  remove 
it  before  re-taking  for  equalization. 

Thus  the  bony  ridge  cuts  into  the  softened 
impression  and  causes  the  hard  part  of  it  (im- 
pression) to  correspondingh"  push  up  and  dis- 
place the  soft  flesh,  to  equalization  of  pressure. 

To  recapitulate:  the  process  is  the  same  as 
we  had  a  while  ago  with  the  case  of  soft,  flabby 
ridge  all  around.  The  idea  is  to  hold  the  loose 
tissues  in  their  normal  position;  then  compress 
and  coiisoUdate  them,  so  as  not  to  yield  much 
when  bitten  on,  and  to  rebound  and  keep  their 
room  filled  air=tight  when  not  under  strain. 

Study  such  cases,  and  study  your  patient, 
and  decide  whether  you  want  to  remove  the 
flabby  lissues  or  equalize  them,  and  then  act 
accordingly. 

A  VALUABLE  REVIEW. 

(Here  the  whole  matter  of  equalizing  the 
soft  tissue  with  firm  ones  was  repeated  in  clinic 
till  the  class  could  explain  themselves.  Also  a 
review  was  made  and  the  class  re^impressed 
with  the  importance  of  conforming  and  post* 
damming,  to  the  purpose  that  plates  may  not 
tip  down  behind  while  bitten  on  in  front,  or 
tip  down  on  one  side  while  biting  on  the  op- 
posite side.) 


IX   Dextal   Prosthesis.  59 

ROOFLESS  PLATES. 

By  a  roofless  plate  we  mean  one  whose  roof* 
center  is  lacking.  It  is  a  fact  that  fully  one* 
half  of  all  ujiper  cases  might  be  made  roofless. 
Indeed,  many  more  could  be  if  we  had  not  mal= 
educated  the  pubHc  to  the  idea  that  dentures 
should  stick  tightly  in  the  mouth. 

I  say  "mal=educated,"  because  from  long 
observation  and  personal  experience  I  'm  con- 
vinced of  the  fallacy.  It  's  not  the  tight'SticMng 
plate  we  need,  but  the  one  that  can  be  worn 
more  loosely  and  more  comfortably  tvithout  be- 
ing th'oicn  down,  or  up,  by  straining  tissues. 

It  is  a  truth  (surprising  to  some  non'think- 
ing  dentists)  that  cases  are  numerous  w^here  a 
roof  covering  the  entire  palate  is  detrimental  to 
retention  of  the  plate,  as  well  as  to  the  comfort 
of  the  ^^earer. 

A  toothless  upper  jaw  with  a  very  hard  cen- 
ter is  frequently  one  of  them.  Especially  is 
this  so  if,  as  is  generally  the  case,  the  rear  of 
the  plate  doesn't  reach  back  beyond  the  hard 
part,  and  doesn't  fit  up  on  the  soft  so  as  to 
make  valve-like  pressure, 

I  mean,  to  plainty  put  it:  if  a  plate  is  cut 
off  too  short  on  a  hard=roofed  mouth,  it  'd  bet- 
ter be  cut  clear  out,  up  to  the  ruga  or  even 
beyond.  In  that  case,  the  plate  would  settle 
as  tlie  ridge  absorbed  and  the  fit  would  still  be 
maintained. 

It  is  sometimes  funny  to  see  dentists  bug 
out  their  eyes  at  the  mention  of  a  roofless  full 
denture  when  they  are  already  making  roofless 
partials,  more  difficult  than  the  others. 

But,  to  make  a  roofless  full  plate  practica- 
ble, its  rim  must  reach  the  proper  height  all 
around,  including  tuberosities,  and  have  a  good, 
close  valve-fit  on  the  inner  edge  thereof. 


60  Greene   Brothers'  Clinical  Course 

This  is  done  by  muscle'trimming  for  height 
and  conforming  for  pressure,  as  you  've  been 
shown   in  other  cases — a  cheek  fit^  so  to  call  it. 

Then  it  must  also  have  the  same  sort  of  a 
fit  on  the  lingual  inner  edge.  Hence  the  plate 
mustn't  be  trimmed  off  quite  to  the  hard  bor- 
der of  the  ridge,  for  there  we  can't  make  the 
necessary  valvespressure  to  prevent  its  tipping. 

It  should  extend  down  to  where  the  mouth 
is  a  little  soft.  And  then,  instead  of  post^dam- 
ming,  we  sidc'press  the  edges  with  firm  tongue 
pressure;  in  some  cases,  with  finger  pressure. 

Don't  attempt  to  get  the  "extra  pressure" 
by  scraping  the  model,  for  there  may  be  vari- 
ous densities  of  the  half-soft  tissues.  Scraping 
is  guess=work  at  best;  and  you  can't  test  it. 
When  sidespressed  with  tongue,  or  even  finger, 
we  can  test  for  satisfaction  of  fit.  And  again 
here  I  repeat  without  ax)ology:  All  conforming 
must  he  done  by  cooling  the  material  while  it  still 
presses  the  yielding  tissues. 

While  an  impression  for  a  roofless  plate  is 
taken,  in  a  general  w  ay,  the  same  as  for  a  roof 
plate,  especial  care  should  be  made  in  every 
step  and  detail. 

The  rim  and  heel  trimming  (very-edging) 
must  dispose  of  all  muscle  strain,  and  yet  in  a 
way  to  leave  no  leak.    ''Relief  without  leak." 

Take  notice:  When  I  say  you  can't  cut  a 
plate  off  where  it  edges  on  a  hard  part,  I  mean 
from  the  middle  of  the  mouth  rearward.  It 
may  rest  on  such  j^laces  forward  of  the  center 
without  harm;  for  the  more  pressure  there,  the 
tighter  it  fits. 

But  I  repeat:  When  you  have  a  very  hard 
place,  better  cover  model  there  with  tin-foil, 
when  packing,  to  provide  for  the  inevitable  set- 
tling of  the  soft  parts  in  adjustment,  by  wear- 


IX   Dextai.   Prosthesis.  61 

ing.     The  softer  the  soft  parts,  the  thicker  the 
tin-foil  should  be. 

INSTRUCTIONS  TO  PATIENTS. 

When  you  make  a  roofless  plate,  be  sure 
to  instruct  your  patient  to  practice  chewing- 
chipped  ham  or  dried  beef  on  both  sides  at  once, 
between  meals,  for  a  week  or  two,  to  evenly 
adjust  plate,  all  around  alike.  This  can  be  done 
also  by  a  habit  of  biting  the  teeth  together 
without  feed,  if  the  occlusion  is  good.  Instruct 
her  to  do  both. 

Well,  in  fact,  this  should  be  the  instruction 
in  all  cases  of  artificial  teeth  on  plates.  It  is 
best,  generalty,  for  patients  not  to  try  eating 
at  table  imtil  they  have  practiced  on  simple 
food,  on  both  sides  at  once,  and  feel  the  need  of 
their  teeth  at  mealstime. 

When  they  can  do  a  little  better  latli  tlie 
teeth  than  tcithout  them,  all  is  safe — "the  Ru- 
bicon crossed."  But  don't  over^do  the  sug- 
gestion of  "perfect  satisfaction"  unduly  soon. 

JNIuch  experience  induces  me  to  insist  on 
this  advice  to  dentists — learning  at  first  on  both 
sides  at  once.  And  they  '11  always  gratefully 
remember  me  for  it,  too. 

EXTRA  SUPPORT  TO  ROOFLESS  PLATES. 

When  you  make  a  roofless  rubber  or  cellu- 
loid plate,  strengthen  it  across  the  front  pal- 
atal surface  with  perforated  gold  or  other  metal 
plating. 

To  do  this,  you  first  fit  your  metal  su])]Jort 
to  the  model  approximately:  then,  in  packing, 
first  lay  down  a  thin  sheet  of  vulcanite:  then 
the  perforated  plate  onto  this  rubber:  and, 
lastly,  another  vulcanite  slieet  on  the  metal. 


62  Greene   Brothers'  Clinical  Course 

But  this  instruction  belongs  to  our  last  les- 
son of  this  Course. 

RETENTION  OF  ROOFLESS  PLATES. 

Roofless  full  plates  will  not  generally  stick 
up  as  tightly  in  the  mouth  as  others,  provided 
the  full  roof  ones  fit  just  right,  and  that  right  fit 
continues.  But  they  stay  quite  well  enough  if 
fitted  properly  and  persistently  worn  to  easy 
adjustment. 

In  furnishing  roofless  plates,  use  careful  judg- 
ment as  to  "indications"  of  the  mouth  and  as 
to  the  good  sense  of  your  patient.  Good  ridges 
with  prominent  heels  indicate  roofless  plates; 
and  real  desire  for  them  indicates  the  wearer. 

Few  people  having  worn  roofless  plates  would 
be  content  with  any  other.  A  roof  does  inter- 
fere with  taste  to  some  extent;  and,  if  in  no 
other  way,  by  obtundin^  the  sensitive  nerves 
of  the  tongue  by  frictional  contact,  the  same 
as  work  with  a  hoe  handle  will  "harden"  the 
fingers  and  hands,  so  a  blind  person  can't  well 
read  raised  letters. 

Though  I  formerly  argued,  in  the  fashion, 
otherwise,  I  now  "know  for  myself,  and  not 
for  another,"  better. 

Don't  hobby'ride  roofless  plates,  but  make 
them  unhesitatingly  when  a  roof  would  be  det- 
rimental or  unpleasant.  Then  get  a  fair  price 
for  'em.  This  you  can  easily  do  with  a  reputa- 
tion for  making  them. 

Here  the  lecturer  sur])rises  the  class  by  show- 
ing a  roofless  denture  in  his  own  mouth  and  chew- 
ing tough  beef  steak  and  ham,  to  their  complete 
satisfaction. 

PARTIAL  UPPER  IMPRESSION. 

Now  we  come  to  the  easiest  of  all  impres- 
sions— partial  upper  cases. 


IN  Dental  Prosthesis.  63 

Cut  your  tray  low,  so  the  material  won't 
run  up  much  onto  the  natural  teeth.  If  it  rims 
high,  you  may  not  know  whether  the  over-lap 
holds  the  impression  tight  or  whether  it  's  the 
suction  to  the  roof  that  does  it,  in  your  test. 

Trim  your  tray  also  a  bit  shorter  behind 
than  you  want  your  finished  plate,  so  you  can 
later  on  post*dam  impression  with  tongue  press- 
ure or  otherwise.     (Index  L.) 

Now  be  dead  sure  your  tray  and  material 
can't  part  company.  Better  have  some  small 
holes  through  the  tray,  in  addition  to  the  melted* 
on,  stick  =  tight  lining  heretofore  shown.  (In- 
dex S.) 

Pile  your  water- warmed  compound  high  up 
in  the  center  and  \\ell  forward,  and  lastly  warm 
well  over  spirit  flame;  then  take  as  show^n  for 
full  mouth.  Cool  tJiorougJdij  with  sponge  held 
on  under  side,  as  shown  before,  and  remove 
with  caution. 

Then  get  length  (Index  L)  and  post^dam 
(Index  P)  as  in  full  case.  In  partials  you  con- 
form only  when  visual  adjacent  teeth  are  miss- 
ing. Mind,  now,  we  're  talkino^  about  jmrtials. 
But,  mark  you,  we  've  had  only  a  simple,  easy 
case,  where  there  were  no  leaning  teeth  nor 
bellsshaped  crowns  to  interfere  with  removal 
of  impression.  "There  are  others."  (Class  re- 
sponds: "Yes,  there  are  others!") 

LEANING  TEETH  AND  BELL=SHAPED  CROWNS. 

In  cases  of  leaning  teeth  and  bell-shaped 
crowns,  you  '11  first  use  some  of  the  "Perfec- 
tion" material  to  build  around  and  core  them 
out  coiie=like*shaped  at  all  ])oints.  Then  var- 
nish the  <!oring  and  cover  quickly  with  tin-foil. 
The  varnish  is  to  hold  the  foil,  while  the  latter 
is  a  separator  between  cores  and  impression. 


64  Greene   Brothers'  Clinical  Course 

But,  before  you  stick^on  the  foil,  cut  a  few 
sharp  notches  in  the  coring,  after  it  is  adjusted 
around  the  teeth. 

Now  treat  your  cored^out  teeth  as  if  they 
were  fully  real  ones;  and  go  on  and  take  the 
impression  accordingly. 

Cool  your  impression  well  before  taking  it 
out  of  the  mouth.  Take  it  out;  the  coring 
will  remain  in  place  around  the  natural  teeth. 
Then  chill  cores  in  place  with  cold  water  tho?'- 
oiighly.  Split  them  in  sections  lengthwise  with 
the  teeth,  then  remove  the  pieces  carefully  A^ith 
pliers  and  place  them  home  in  the  impression. 

This  "Perfection"  material  breaks  satisfac- 
torily when  cold.  The  cold  water  may  be  ap- 
plied  with   syringe,   cotton,   or   bibulous   paper. 

RECAPITULATION  ON  CORING. 

In  cases  of  leaning  teeth  and  bell-shaped 
crowns,  We  take  sectional  impression;  then  join 
the  parts  and  make  our  model.  If  a  plaster 
model,  we  sometimes  strengthen  it  with  wire 
and  pins.    But  better  use  metal  models. 

Of  course,  some  of  this  ma}^  require  careful 
manipulation,  but  no  more  so  than  many  other 
operations  dentists  do  and  without  complaint. 

PLASTER  IMPRESSIONS  FOR  PARTIAL  PLATES. 

A  simple  way,  however,  for  accomplishing 
the  results  just  shown  is  to  first  take  the  im- 
jDression  in  modeling  compound  only  approxi- 
mately; then  complete  it  with  plaster. 

To  do  this  we  take  the  impression  and  work 
it  upsand^down,  as  it  cools,  slowly  in  the  mouth. 
After  taken  out,  we  find  it  has  "drawn"  and, 
of  course,  doesn't  fit.  It  loosely  slips  over  the 
leaning  and  bell-shaped  teeth,  as  expected. 


IX   Dental   Prosthesis.  6.5 

When  out  and  cooled  we  cut  it  off  at  rear  for 
length  of  plate  (Index  L)  and  post*dam  it. 
(Index  P). 

Then  cut  out  the  modeling  c(mipound  all  over 
the  roof  to  about  1/16  of  an  inch  deep;  and  that 
part  next  to  the  leaning  and  bell=shaped  teeth  a 
little  bit  deeper;  and  say  as  far  out  as  ^  of  an 
inch  from  these  "crooked"  teeth.  (This  out=cut 
is  to  be  filled  with  plaster  a  minute  later. ) 

When  cutting  out  the  modeling  composition 
leave  a  thin  bit  of  it  standing  next  to  the  sockets 
of  these  leaning  and  bell'shaped  teeth,  to  prevent 
the  thin  plaster  from  running  down  into  the  sock- 
ets while  it  is  being  spread  into  the  cut=out,  with 
a  knife  blade. 

Xow  after  we  've  cut  out  our  com])()un(l  tlnis 
we  scarify  the  outwent  so  the  plaster  will  stick  \o 
it,  we  moisten  the  gums  and  teeth  with  a  half* 
and-lialf  mixture  of  olive  oil  and  glycerine  so  the 
plaster  won't  stick  to  them. 

Xow,  the  last  care  before  taking  the  imjjres- 
sion  is  to  hurriedly  replace  our  impression  back 
into  the  mouth  and  out,  to  make  sure  the  way  is 
clear  for  the  "pass=word"  impression  we  re  going 
to  take.     ( Index  V ) . 

X"ow,  we  11  fill  the  cut-out  with  this  creamy' 
like  (not  watery)  ])]aster,  turn  it  up=side=d()wn 
and  ])()ur  it  about  all  out;  add  a  little  back  onto 
tile  centei-  and  sli])  it  into  tlie  mouth  and  ])us]i  up 
till  the  natural  teeth  go  fully  down  into  their 
sockets  in  the  impression. 

Xow  we  '11  hold  it  there,  or  let  patient  do  so 
till  the  remnant  of  plastei-  in  the  bowl  is  fully  set 
and  hard. 

Here  comes  the  ''tug=()f=war"!  Remove  it 
from  the  mouth,  oh,  so  slotcli/  and  carcfulli/! 
The   plaster  will  hang  almost  air=tight  and   as 


[51 


66  Gkeexk   Bkothers'  Clinical   Course 

if  glued  to  the  natural  teeth.  And  woe  if  the 
eonipouud  hasn't  been  perfeetly  secured  to  the 
metal  tray!  Of  course  you  11  have  to  go  through 
a  few  educating  come^loose  sci"apes  to  make  you 
careful. 

It  \s  wiggle  and  pull,  and  pidl  and  wiggle, 
harder  and  harder,  till  '^somcthifi^'  gives,"  even 
when  results  are  as  intended.  It  is  the  film  of 
plaster  that  has  ])ulled  loose  from  the  approx- 
imate niodeling^compound  impression.  The  ar- 
rangement was  made  for  just  this  intended  hi-eak- 
ing=l()ose;  so  no  harm  done. 

We  push  the  loose  piece,  or  pieces,  of  plas- 
ter back  tiglitly  to  place  ( with  thin  cenient 
if  necessary),  and  now  have  a  perfect  plaster 
facing  to  the  entire  approximate  compound 
impression. 

Our  ])ost-danuning  strij)  left,  has  forced  the 
flowing  plaster  to  ecjualize  the  mouth's  inecjual- 
ities.  We  11  dry  our  impression,  varnish  it.  and 
make  oin-  model;  same  as  in  case  of  full  mouth. 
])laster  or  metal.  To  strengthen  the  ])laster  teeth 
on  the  model  stick  a  carpet  tack  down  in  the 
center  of  the  tooth  socket  in  the  impression  before 
pouring. 

Bear  in  mind,  if  you  don't  post-dam,  you  '11 
]n'o])a})ly  have  no  fit  at  rear  and  no  equalized 
roof  pressure.  Without  post=damming,  we  'd 
have  merely  an  old=fashioned,  hap^hazard  fit; 
because,  if  the  plaster  can  escape  without  ])ush- 
ing  up  the  soft  parts  it  will  do  so.  That  is,  it 
goes  where  it  meets  least  resistance.  Xon^Howmg 
])laster  might  press  up  too  hard. 

Only  a  propcrlij  post^dammed  rear  will  in- 
sure e(jual=j)ressure  plaster  fit  over  the  roof. 
But  this  correct  post^damming  can  be  Ixiuncn 
only  by  test.  If  too  strong,  the  tissues  would 
push  the  denture  down  behind.    xVnd  that  \s-  what 


IX   Dental   Prosthesis.  67 

often  happens  when  using  a  metal  tray  turned  up 
too  high  behind. 

Still,  as  plates  made  by  the  old  methods 
oftener  fit  up  too  Ughtli/  than  too  tightly  behind, 
tlie  manufacturers  of  turnnip=behind  trays  have 
that  one  mitigating  circumstance  as  an  apology; 
just  this  single  one,  hardly  worth  the  mention. 

TO  TEST  A  PLASTER  IMPRESSION. 

Just  before  taking  a  plaster  impression  any 
where  moisten  the  mouth  (and  teeth  if  anj^)  with 
a  few  drops  of  a  half-and=half  mixture  of  olive 
oil  and  glycerine,  to  pre\'ent  adhesion. 

To  test  for  the  correctness  of  an  old-fashioned 
plaster  impression,  just  trim  it,  after  taken,  ex- 
actly as  you  want  your  finished  plate  to  be,  length 
and  all;  metal  tray  and  all.  Then  varnish  it,  and 
soap  it  to  prevent  adhesion  (not  suction),  and 
return  it  to  the  mouth. 

Have  patient  make  the  usual  plate^wearing 
movements  generally  on  the  impression,  if  she 
can  laugh,  bite  down  on  lier  finger  on  the  tray, 
and  can  swallow  without  dislodgement,  she  could 
do  so  on  a  plate  made  from  it.  If  not,  then  very 
])robably  not.  But  you  \\  know  one  or  the  other 
in  a(hance. 

But  you  'd  have  difficulty  in  so  trimming  and 
testing  an  "ancient,"  deep,  long  metal  tray.  But 
the  test  would  test  all  the  same. 

But  there  'd  be  further  trouble  with  your  old- 
fashioned  plaster  im])ressi()n.  After  you  had 
taken  and  tested  it  and  found  it  wanting,  you  W 
have  a  whole  lot  of  trouble  to  correct  it. 

You  eoiild  do  it,  in  a  way,  however,  l)y  oiu* 
methods,  by  tracing^on  compound,  very-edging, 
conforming,  })ost=damming  and  re=taking,  with 
flowing  plaster. 


68  Greene   Brothers'  Clinical  Course 

]5ut,  doctors,  just  stop  and  fJiiiik  and  have 
a  laugh  over  the  fun  you  would  have  in  taking 
your  correctable  impression  in  plaster,  in  a  high, 
cheek=spreading,  long,  heavy^metal  tray,  witli  a 
regulation  long  handle. 

PLASTER  IMPRESSIONS  IN  MODELING=COMPOUND 
TRAYS. 

^lany  years  ago  the  elder  one  of  the  two 
Greene  Brothers  (the  late  Dr.  P.  T.,  of  Xew 
Albany,  Ind.)  originated  and  taught  for  year;* 
(as  a  secret)  the  now  common  method  of  taking 
first  an  approximate  impression  in  hec's'Tjcacc  (in 
later  years  substituting  modeling  compound)  and 
then  using  in  if  a  thin  layer  of  very  soft  plaster 
for  the  permanent  impression. 

It  importantly  amounted  to  having  a  better 
fitting  tray  than  could  ]^e  made  of  metal,  and 
therefore  was  a  vcrji  decided  improvement  over 
the  old  way  of  a  common  impression  in  a  non= 
fitting  tray. 

But  it  was  not  a  fully  complete  way,  nor  a. 
fully  correct  one.  It  didn't  give  the  exact  height 
nor  the  length  of  the  i^late.  Xor  did  it  always 
give  a  valve-pressure  fit  up  behind,  nor  around 
the  heels,  nor  in  the  inner  side  of  the  top  of  rim. 
Xor  did  it  pretend  to  give  the  fullness  of  the  lip 
and  cheek  features. 

Plaster,  if  soft  enougli  to  flow  to  the  different 
])arts  wliere  needed,  will  go  where  it  meets  least 
resistance;  hence  will  run  out  behind  and  else- 
where witliout  lifting  the  yieldable  tissues  up  to 
the  essential  valve=pressure  strain. 

But  no  better  ])roof  is  needed  to  show  up 
the  faultiness  of  plaster,  especially  in  a  non- 
fitting  metal  tray,  tlian  to  take  two  or  more 
impressions  from  the  same  moutli,  in  the  same 


IX   Dental   Prosthesis.  69 

^\ay,  and  then  make  a  model  on  one  and  try  it 
in  the  others.  It  will  seldom,  if  ever,  fit  another 
impression  than  the  one  it  was  made  from;  nor 
often  fit  any  two  very  nearly  alike.  Think  of 
tlie  chanee  in  getting  tliem  alike! 

In  order  to  get  them  alike,  yon  'd  need  to 
have  two  metal  trays  alike,  mix  your  plaster 
eaeh  time  alike,  and  give  the  same  pressure  at 
the  same  angles  each  time  ahke.  This  is  a  math- 
ematical remoteness  next  to  an  impossibility. 

In  a  modehng=compound  impression  and  by 
our  system,  we  "11  not  ask  nor  care  whether  it  's 
like  another  or  not.  AVe  don't  judge  an  impres- 
sion by  its  looks. 

Our  system  is  one  of  absolute  test.  ^Ve 
simply  make  one  that  will  stand  the  practical 
test,  and  be  sure  of  it.  And,  doctors,  this  can 
be  done  even  with  good  bee's=wax  better  than 
with  all  plaster. 

TO  TAKE  TEST  IMPRESSION  IN  PLASTER. 

To  illusti-ate  the  principles  here,  I  may  have 
to  repeat  a  little.  We  '11  go  back  and  take  u[) 
our  finished,  tested  impression  of  modeling  com- 
pound. Of  course,  that  'd  be  all  we  'd  need  in 
a  practical  case.  But  now.  sav,  we  want  it  in 
plaster. 

If  it  is  air-tight  (which  it  ])roved  to  be  in 
the  test),  it  's  also  water=tight.  Now,  I  '11  pour 
in  a  halfsteaspoonful  of  water  and  push  it  up  to 
])lace  at  similar  strain  as  when  tested.  Xow,  icJiat 
becomes  of  the  tcatei'? 

It  "s  a  simple  pro])ositiou.  It  can't  pass  our 
conformed  rim  and  j)ost=dammed  rearsi)arts 
without  strain  effort.  It  can  run  all  over  the 
surface  inside  more  easily  than  to  strain  through 
the  dammed=con formed  environment. 

It  will  do  more;  it  '11  even  exert  a  strain  inside 
equal  to  that  necessary  to  force  through  its  mar- 


70  Greene   Brothers'  Clinical  Course 

ginal  hindrance.  So,  by  the  law  (of  following 
the  line  of  least  resistance),  it  must  ee[ualize  the 
stress  on  all  parts  inside  with  that  of  the  valve* 
pressed  margin,  before  it  can  escape.  Xor  will 
there  be  any  to  escape  unless  there  is  more  than 
necessary — a  surplus. 

Well.  now.  for  instance  and  for  illustration, 
we  '11  command:  "Hokus==pokus,  presto  change!" 
And  our  confined  water  becomes  a  sheet  of  ice. 
Take  it  out  of  the  mouth,  and  we  see  a  film  of 
ice  that,  in  its  difference  of  thickness  at  different 
jilaces,  shows  just  what  the  impression  lacked  of 
exact  equal^pressure  strain  before. 

If  the  ice  is  the  same  thickness  all  over, 
it  then  shows  the  strain  was  equal  all  over 
the  modeling  compound  before  the  ^vater  was 
inserted. 

You  now  see  I  have  made  equal  strain  by 
hydraulic  pressure.  But  suppose  there  had  been 
some  holes  through  the  compound.  Would  the 
water  have  pressed  up  the  soft  parts  and  caused 
the  equal  strain?  Certainly  not.  It  would  have 
run  out  through  the  holes,  to  follow  the  way  of 
least  resistance.     That  is  all  very  plain. 

Now  let  us  play  the  same  game  with  this 
thin,  creamy,  easy'fiowing  plaster.  It  will  not 
flow  quite  as  reiulily  as  the  water  did,  but  well 
enough;  provided,  of  course,  the  same  conditions 
])revail  as  did  before. 

We  \\  take  the  same  impression  we  had  be- 
fore. We  '11  mix  some  (piick'Setting  plaster  to 
about  the  consistency  of  medium  cow\s=cream 
and  pour  into  the  impression,  turning  this  way 
and  that  way  till  it  covers  all  the  com])ound  up 
to  withiii  about  an  eighth  of  an  inch  of  the  top. 
We  \\  liold  it  there  for  a  few  seconds  and  sling 
it  all  out  but  merelv  enouL;'!!  to  hide  the  surface. 


IN   Dental   Puostiiesis.  71 

Then  witli  the  hhide  of  our  knife,  or  small  spatula, 
we  '11  traee=^on  a  smidgen  from  same  bateh  along 
the  roof  center  from  front  to  rear.  Tlien  (juickly 
re^take  with  ti'emuloiis  niotion,  at  normal  j)late= 
wearing  pressui'e. 

In  this  re=taking  we  still  use  the  long  flexible 
middle  finger  of  our  right  hand,  of  course. 

If  our  thin^flowing  ])laster  is  in  ])roper  con- 
dition, the  little  smidgen  of  excess  in  the  center 
will  wave-move  the  rest  all  ()\er  the  surface  to 
perfect  ecjuali/ation  of  ])ressure.  But  bear  in 
mind,  if  plaster  even  begins  to  set,  in  the  least, 
before  pressure  to  the  mouth,  there  '11  probably 
be  a  failure;  just  as  we  'd  have  had  if  we  'd  have 
waited  till  the  water  had  l)ecome  musli^ice.  Now, 
doctors,  are  you  fully  impressed  that  a  ready* 
Mowing  condition  of  the  plaster  is  essential 

And  do  you  fully  understand  that  it  's  just 
as  essential  for  ])erfect  ecjual  j)ressure  that  plas- 
ter must  be  coiiiiucd — by  conforming  and  post* 
damming!' 

Well,  anyhow,  let  me  clinch  your  undei'stand- 
ing  and  memory  with  what  has  been  cidled 

"THE  PASS=WORD  FOR  THE  GREENE  METHOD  OF 
PLASTER  IMPRESSIONS." 

"Crcfonff'lih'c  pldslcr:  in  rcadii'fioidng  con- 
(lifion;  con  fined;  fiornuil  j)l(itc'rci'ariug  pressure, 
Ti:itli  icdve-motiou." 

1  f  rightly  done,  it  's  not  expected  there  11 
be  any  excess  to  flow  out  behind,  nor  over  the 
I'im:  but  should  thei-c  be  a  little,  just  wij)e  it  off 
outwai'dly,  after  taken,  and  use  the  compound 
<^(\^^L'  only  as  the  guide  for  model. 

If  an  im])ression  is  taken  in  this  way,  it  will, 
in  some  ca.ses,  fit  technically  better  than  the 
"modeling*com])()und   ti-ay"  did  before:  but  sel- 


72  Greexe   Brothers'  Clixical  Course 

dom  praciicalUj  so.  For  it  stood  the  test:  and 
probably  (luite  as  well  as  the  plaster  addition. 

Then,  practically  it  makes  little  difference 
what  mateiial  is  used,  just  so  all  parts  of  the 
impression  will  stand  requisite  iefiis.  And  this 
should  include  the  fullness  of  the  lips  and  cheeks, 
too.  T///.S'  necessity  has  been  the  "mother  of  our 
new  invention"' — the  tray  with  removable  handle. 

To  test  a  "pass^word"  plaster  impression 
made  in  this  way,  you  '11  let  it  dry,  varnish  it,  or 
soap  it,  let  the  varnish  dry.  and  then  soapstone* 
powder  it  before  the  test. 

If  it  doesn't  stand  the  test,  you  haven't  lol- 
lowed  the  five  points  of  the  "pass*word."  You 
have  probably  gotten  your  plaster  too  thick,  or 
let  it  begin  to  set  before  using  it.  Watch  out 
especially  for  these  two  probable  troubles. 

I  hope  you  now  see  the  difference  between 
this  "pass* word"  perfect  way  of  taking  a  plas- 
ter impression  and  our  old  improvement,  first 
introduced  about  twenty-five  years  ago;  which 
was  merely  taking  a  common  modeling^com- 
pound  or  wax  impression  and  pouring  plaster 
into  it,  and  re=taking  it. 

My  first  "Eureka"=dance  over  an  "improve- 
ment in  plaster  impressions"  was  nearly  forty 
years  ago.  when  I  varnished  and  soaped  a  plaster 
impression  and  re=took  it  in  creamy,  soft  plaster. 
And  it  teas,  indeed,  a  great  advance  ste])  at  the 
time.  It  has  since  been  known  as  a  "double  plas- 
ter impression." 

I  make  these  remarks  because  some  who 
have  gotten  onto  our  first,  long=ago=introduced 
improvement  jump  to  the  notion  that  they  "al- 
ready know"  our  present  perfect  pass=word  meth- 
od. Our  perfect  ecpialization  of  to-day  was 
only  hinted  at  in  oin*  old-time  mere  improve- 
ments. 


IX   Dental   Prosthesis. 


WHY   PLASTER   AT   ALL   FOR   IMPRESSIONS? 

Some  one  of  the  class  always  asks:  "Why 
use  any  plaster  at  all,  after  your  compound  im- 
pression stands  the  testT'  Well,  really  uo  use, 
in  full  cases.  And  I  show  you  this  "pass=word 
method"  mostly  to  expose  the  fallacies  of  plas- 
ter impressions,  taken  in  the  old  way.  with  the 
old,  ridiculous,  non-fitting,  mouth  =  stretching- 
trays,  with  nauseating,  choking  surplus  material. 

And  1  don't  think  you  '11  ever  take  many 
more  plaster  impressions  for  full  Jieic  dentures, 
after  you  know  how  and  have  some  practice  in 
using  this  "Kerr  Perfection"  compound  mate- 
rial. But  you  '11  frequently  use  the  "pass-word" 
equalizing  method  in  cases  of  upper  partials 
where  there  are  leaning  natural  teeth  or  hell- 
shaped  crowns:  also  in  reiitting  and  renewing  old 
plates. 

In  taking  a  plaster  impression  by  the  i)ass= 
word  way,  never  use  more  than  a  spoonful  of 
plaster.  If  careful,  none  of  it  escapes  to  "gag" 
or  disgust  the  patient. 

I  may  mention  here,  by  the  way,  that  if  you, 
from  the  first,  conclude  you  want  to  take  a  pass= 
word  plaster  inq)ressi()n.  it  isn't  necessary  that 
the  compound  should  fit  the  roof  of  the  mouth 
exactly — exce])ting  at  the  jjost^dammed  rear:  for 
the  five  conditions  of  the  j)ass=word  will  force  a 
fit  everywhere,  anyhow. 

We  make  a  model  in  a  thus  plaster^lined  im- 
])ression  the  same  as  in  a  com])ound  one,  except- 
ing that  in  the  ))laster  we  use  varnish  as  a  sep- 
arator instead  of  lather  oi-  powdered  soapstone. 

And  lastly:  if  yon  use  the  Crreene  ready= 
made,    non^changeahle    models    in    any    sort    of 


74  Greene   Brothers'  Clinical  Course 

plaster  iiii}3ressioii,  you  fit  them  to  it  the  same  as 
to  one  of  modehng  compound. 

A   "QUICK=STEP"   DENTURE. 

If  you  wish  to  make  a  plate  quicldij  and  ask 
no  better  one  than  you  've  l)een  making  of  vul- 
canite, but  still  want  to  knozc  in  advance  how 
it  will  iif,  I  11  now  show  you  how  you  can  do  it 
in  from  two=and=a=half  to  three  hours,  from  start 
to  finish. 

I  say  "no  better  than  you  've  been  making" 
because  you  've  i)rol)ably  been  making  plates 
that  break:  when  a  pro])erly  vulcanized  plate  of 
good  vulcanite  will  not  break. 

The  samples  sent  out  by  the  manufacturers 
will  not  ])reak:  they  '11  bend  rather  than  break. 

But  the  matter  of  vulcanizing  will  come  up 
in  the  last  one  of  our  three  lessons — the  "third 
degree. 

Supposing,  for  instance,  your  case  is  a  full 
upper  one:  Fit  your  metal  tray  to  the  mouth — 
for  ([uickness,  by  practitioner's  method.  ( Index 
P.)  Then  soapstone  it,  so  impression  will  read- 
ily separate  from  it. 

Take  a  modeling^compound  impression  and 
test  it,  as  I  've  shown  you.  Then  tap  it  out  of 
the  tray  and  cool  it  still  more  than  you  did  in 
the  mouth. 

Now  trim  off  the  sides  down  thinslike:  and, 
where  you  thus  remove  the  compound,  tracer 
on  some  sticky=wax  to  stick  your  teeth  to. 
Fairly  good  old-fashioned  sticky-wax  is  made  of 
three  parts  bee's-wax  and  one  part  rosin,  melted 
together  and  strained  into  a  porcelain  plate.  But 
the  Detroit  Dental  ^Nlfg.  Co.  are  now  making  a 
much  ])etter  article — "The  Greene"  sticky  wax. 


IX   Dextal   Prosthesis. 


/o 


Now  stick  your  teetli  onto  the  stickv'vvax, 
seeing-  first  that  the  centrals  are  in  proper  posi- 
tion. Then  j^ut  it  all  into  the  mouth  and  ask 
patient  to  bite  down  lightly  and  slowly — "Slow- 
ly, ^ladam,  slowly!" 


Fic.  7. — 'J'y))ic'al  <)ld-st_\ie,  tissue-straining,  non-tested  jiiaster 
impression;  taken  in  average  deep  tray,  not  fitted  to  nioutii.  A 
|)late  made  from  it  would  iiave  to  i)e  guess-file-trinimed  to  fit  mov- 
ing muscles — next  thing  to  impossibility. 

Fig.  8. — Plaster  tested  imjiression,  "})ass-word""  method. 
("Creamy-like  plaster;  in  ready-flowing  condition,  confined;  nor- 
mal ))late-wearing  pressure;  with  wave  motion.")  Modeling  com- 
pound edge-rim  accurately  muscle-trimmed.  Xo  trinuniiig  of  ])late 
a  fter  made. 

AVhen  the  teeth  show  the  desired  length,  stop 
her — "Sto}),  sto}),  Madam:  stop  thei-el" 

Vou  now  have  the  show -I  eni^ih  of  the  teeth. 

Now,  while  she  bites  down  steadily,  use 
your  fingers  to  adjust  the  teeth  down  onto  the 
occluding  lower  ones.  That  is,  adjust  them  to 
come  togethei",  just  as  you  want  them:  and 
also  to  fill  out  the  lij)  as  you  want  it — well,  just 


76  Greene   Brothers'  Clixical  Course 

as  you  always  do  in  fitting  an  articulated  set  of 
teeth  on  a  base-plate  in  the  mouth.  In  fact,  j^ou 
are  simply  using  the  tested  impression  as  a  base- 
l^late. 

When  the  teeth  are  occluded  and  adjusted 
to  the  features,  take  the  case  out  of  the  mouth, 
cool  it  thoroughly,  and  "wax  up"  the  teeth  as 
usual.  While  the  waxing^up  is  being  done,  the 
impression  sliould  be  kept  cool  inside  by  cold 
wet  cotton  in  it. 

Now  place  it  back  into  the  mouth,  and,  // 
necessary,  re=conform  and  re- post-dam  it. 

When  it  looks  and  fits  as  you  want  it  to,  take 
it  out  and  cool  it  well.  Then  pour  the  model; 
that  is,  fill  the  impression,  and  at  same  time  half* 
flask  it,  in.  the  usual  way,  teeth  upward.  Your 
case  is  now  in  first  half  of  the  flask,  but  the  teeth 
are  still  on  the  thick  impression  instead  of  on  a 
thin  wax  base*plate. 

Now,  as  soon  as  your  model  under,  or  in, 
impression  is  hard,  take  yopr  pocket*knife  and 
heat  the  point  of  it  and  cut  down  through  the 
compound  impression,  all  around  on  the  palatal 
side  of  the  teeth,  and  remove  the  compound. 

Then  slip  in  thin  base=plate  wax  where  the 
compound  came  from,  and  wax  up  all  around 
on  the  inner  side  of  the  teeth.  Sometimes  we 
place  a  strip  of  modeling  compound  on  the  outer 
side  of  the  teeth,  and  cool  it,  to  hold  them  to  place 
while  we  wax*up  on  their  aforesaid  palatal  side. 

When  the  case  is  waxed,  you  are  ready  to 
double*flask  it.  But  before  flasking  adjust  a 
Greene  Occlusion  Retainer  onto  the  ends  of  the 
teeth  to  prevent  misplacement  of  teeth  in  pack- 
ing and  vulcanizing. 

See  that  the  metal  edges  of  your  flask=rims 
come  together  witliout  rocking.  This  to  preserve 
your  occlusion. 


IX   Dental   Prosthesis.  77 

Now,  ill  filling  the  first  half  of  the  flask,  be 
sure  to  fill  the  impression  carefully  first,  without 
l)ubbles;  for  that  becomes  the  model. 

On  opening  flask,  merely  warm  it,  for  it 
won't  do  to  Jieat  modeling  compound;  and  there 
is  some  of  your  impression  in  there  yet. 

P^inally  pack  and  vulcanize  and  finish  as 
usual.  As  your  imjjression  gave  you  the  length 
and  (lei)th  of  your  plate,  and  the  thin  wax 
base=plate  gave  it  the  thickness,  there  will  be 
little  or  no  filing  or  scraping  to  do;  so  the 
finishing  will  be  but  a  short  job. 

But  understand  me:  Quick  plates  are  justi- 
fiable only  in  cases  of  emergency  and  ''push- 
ency."  They  shouldn't  be  made  from  a  com- 
mercial point  of  view. 

To  make  a  good  rubber  plate,  more  time 
should  be  used  by  the  case  in  the  flask  after  the 
jiask  it  eold,  to  say  nothing  of  the  proper  slow- 
ness in  cooling.  Every  vulcanite  case  should  be 
left  in  the  flask  over  night  to  "season,  "  if  i)()s- 
sible. 

There  are  other  ways  to  make  (|uick=step 
dentures.  But  this  is  preluding  and  forestalling 
our  thirdslecture  lesson. 

REFITTING  OF  PLATES. 

Ill  all  plate=work  practice  there  is  no  more 
common  need  than  refitting  of  plates.  And  yet 
ill  my  travels  among  dentists,  ten  months  in 
the  year  for  fourteen  years,  I've  not  found  more 
than  one  in  ten  who  knows  even  the  old  methods 
of  doing  this  sim])le  work;  the  exceptions  being 
largely  in  favor  of  tlie  old-timers  in  "mechanical 
dentistry." 

When  ])lates  don't  fit,  they  are  usually  "made 
over,"   at   imicli  loss  of  time  and   inconvenience 


78  (JREEXE   Brothers'  Clixhai,   ("orRSE 

and  with  the  usual  uncertainty  ahnost  insepar- 
able from  guess*work  methods. 

The  old  way  of  ]-efitting  a  plate  is  simply  to 
line,  or  "halfssole,"  its  surface.  And  it  is  a 
partial  success,  as  far  as  it  goes.  But  it  doesn't 
contemplate  any  re=adjustment  of  the  teeth  in 
any  way.  nor  does  it  include  the  rim=and=heel* 
valve  fit  that  I  've  shown  you  on  full  ])lates.  And 
these  things  that  the  old  way  doesn't  include  are 
among  the  most  necessary  of  all.  For  the  refit- 
ting of  merely  the  main  surface  of  a  plate  is 
often  curing  but  a  small  part  of  the  whole 
trouble. 

Xow  I  will  show  you  how  to  refit  the  whole 
thing,  including  occlusion  and  position  of  teetli 
if  needed: 

TEMPORARY    REFIT    WITH    MODELING    COMPOUND. 

I  "11  assume  you  want  to  make  only  a  partial 
retit,  and  that  only  temporary,  till  you  get  time 
to  re^adjust  and  refit  it  fully  and  permanently. 

This  is  done  with  "Perfection"  modeling 
composition.  You  '11  keep  on  hand  a  supply  of 
thin  sheets  of  it,  say  one-sixteenth  of  an  inch, 
thick.  You  can  make  them  by  simply  pressing 
soft  compound  out  on  a  slab  of  glass  or  marble 
with  a  bottle  or  common  tumbler.  But  the 
Detroit  Dental  ^Manufacturing  Company  are 
putting  this  on  the  market.  You  '11  keep  differ- 
ent thicknesses  of  these  ready-made  "wafer  " 
sheets  on  hand. 

To  refit,  you  first  scrub  the  ])late  clean  and 
sand=]japer,  or  scrape,  its  palatal  surface  a  lit- 
tle: then  dry  it  well.  Then  heat  your  wafer 
sheet  of  compound  and  lay  it  onto  the  plate  and 
rub  hard  till  it  attaches  perfectly  thereto — not 
merely  till  it  presses  closely,  but  till  it  actually 


IX   Dental   Pkosthesis.  79 

adheres.     This  iniist  cover  the  icliolc  surface,  of 
course. 

Next  press  another  thin  wafer  onto  this  first 
one,  still  dry  heat.  Then  dip  the  plate  into  hot 
water  to  soften  the  com])ound.  and  (juickly  put 
it  into  patient's  mouth  and  have  her  hite  down 
lightly  on  the  teeth. 

Do  this  two  or  three  times,  when  you  "11 
have  a  good  (old=fashioned)  refit  in  "Perfec- 
tion" compound  that  will  remain  for  days  or 
weeks,  owing  to  the  thoroughness  of  the  work. 
And  you  have  done  it  in  a  very  few  minutes. 
But  don't  forget  to  tell  patient  not  to  heat  her 
plate  in  hot  water  nor  otherwise. 

Should  the  mouth  change  again,  or  the  com- 
pound get  dis2)laced,  sim])ly  redieating  in  hot 
water  and  re*adjustment  may  he  sufficient  for 
another  cori'ection. 

This  temjjonir//  refitting  with  modeling  com- 
jjound  a])])lies  to  metal  ])lates  as  well  as  to  vul- 
canite and  celluloid:  when  done  with  proper 
thoroughness,  of  course. 

But  c()m))oun(l   \\()n't   stick  to  the   cdi>;es  of 
plates:    so    this    couldnt    he    even    a    complete 
temporary  refit,  though  good  as  far  as  it  goes. 
Compete  lefits  must  include  the  edges  of  plates 
as  well  as  the  ])alate  and  ridges. 

PERMANENT  REFITS  WITH  VULCANITE. 

To  refit  a  vulcanite  plate  completely  and 
permanently — rim.  heels,  and  tuberosity,  in- 
cluding position  of  teeth  and  occlusion, — you 
first  see  that  the  teeth  stand  as  desired.  If  not, 
oil  them  and  heat  them  with  a  mouth  l)low=i)i[)e, 
and  ])ush  and  i)ull  them  to  the  positions  desired, 
and  hold  them  in  ])lace  till  cool.  This  relates 
mostly  to  the  front  six,  hut  may  include  any 
others. 


80  Greene   Brothers'  Clinical  Course 

If  there  are  any  cracks  in  the  plate  from 
changing  position  of  the  teeth,  pack  softened 
vulcanite  into  them,  as  you  'd  pack  soft  foil  into 
a  carious  cavity. 

Next  see  that  the  teeth  occlude  with  their 
opponents  as  you  want  them  to,  whether  the 
latter  he  natural  or  artificial. 

Not  necessary  that  the  plate  itself  should 
even  touch  the  mouth  in  this  re=occlusion;  just 
so  that  the  teeth  come  together  properly. 

If  any  tooth  is  too  long,  either  grind  it  off 
or  take  it  out,  make  more  numi  aho^'e  it  and  then 
set  it  back  up  deeper  into  the  plate.  If  one  is 
too  short,  loosen  it  and  pull  it  down  to  proper 
touch  against  its  opponent. 

Your  teeth  now  both  set  and  occlude  as  you 
wish  them  to. 

Xext  file  the  rim  of  the  old  plate  down  below 
where  there  is  any  under=cut,  including  around 
the  tuberosities,  and  trace=on  enough  modeling 
compound  for  a  new  rim;  and  cover  the  whole 
jDalate  and  ridge  surfaces  with  a  facing  of  thin 
compound,  as  in  a  temporary  fit  with  compound. 

With  your  material  thus  in  ])lace,  dip  the 
plate  into  hot  water  and  have  ])atient  take  her 
own  impression  (in  the  old  denture)  by  biting 
down  lightly.  Do  this  twice  or  three  times  if 
necessary.  When  it  will  stick  u])  in  the  mouth, 
that  's  proof  that  it  fits. 

When  the  roof  and  ridge  stand  the  test,  then 
go  on  and  very^edge  the  rim  all  around.  Be  sure 
each  muscle  has  valve'tight  room  to  move  in; 
that  is,  I'elief  without  leak. 

Then,  next,  you  1\  conform  all  around,  in- 
cluding behind  tuberosities,  as  in  an  original  im- 
pression. 

Till  now  we  've  left  the  most  im])ortant  step 


IX   Dextal   Prosthesis.  81 

yet  to  be  done:  the  valve^fittiiig  of  the  posterior 
edge  of  our  plate's  palate. 

If  the  old  plate  reaehes  l)ack  to  where  it 
should — that  is,  onto  the  yielding  soft,  and  not 
onto  the  moving,  straining  soft, — it  has  been 
already  post^danmied,  in  the  taking  of  the  im- 
pression, by  biting.  That  is,  the  hard  plate  has 
foreed  the  eompound  up  against  the  soft  tissues 
and  made  the  needed  valve*pressure  strain  thei'e. 

If  it  doesn't  go  back  far  enough,  you  '11  file 
it  off  square  and  trace=on  enough  modeling- 
compound  to  make  it  reach  into  the  stationary 
soft  tissues.  File  it  s(]uare  to  vulcanize  more 
length  onto  it. 

^Vhen  you  get  it  long  enough,  with  a  little 
to  s])are,  you  then  apply  the  rules  for  getting 
exact  length,  and  post=dam  pro2)erly,  preferably 
by  ]Method  A — ^^tongue  pressure. 

You  now  have  the  set  of  teeth,  the  "denture," 
as  you  want  it.  It  stands  the  test  of  mouth  move- 
ments. Ciet  your  flask  ready.  See  that  its  edges 
fit  together  in  a  way  not  to  allow  any  tilting,  for 
that  iiiiglit  harm  the  occlusion. 

Fill  tlie  lingual  side  of  ])late  carefully  with 
])laster,  avoiding  all  air=])ub})les,  and  at  same 
time  fill  the  first  half  of  the  fiask  with  ])laster, 
and  push  plate  into  it  with  teeth  ])()inting  down- 
ward— after  having  adjusted  and  plastered  on 
your  Greene  Occlusion  Retainer.  Then  scra])e 
off  excess  side  plaster  and  varnish  with  Kerr 
sejjarating  fluid  as  usual  in  fiasking. 

Now  fit  on  the  ring  of  your  fiask  and  "dou- 
ble^fiask."  First  carefully  fill  your  impression, 
same  as  if  you  were  making  a  model;  for,  indeed, 
that  's  what  you  are  doing — the  very  one  you  are 
going  to  vulcanize  onto. 

I^et  your  plaster  harden  well,  the  remainder 
in    vour   ])()\vl    beino-  vour    "uide.     When    hard. 


161 


82  Grkexe   Brothers'  Clixical   Course 

jjlace  the  flask  over  a  spirit  name  or  on  a  warm 
stove  and,  wlien  you  can  feel  it  is  slightly  warm 
through,  open  from  tlie  heel  first. 

Your  flask  is  opened,  and  your  model  is  in 
the  last  half  of  it.  Cover  it  with  thin  tinsfoil  and 
cut  some  small  vents,  and  it  '.s  readv  for  use. 

Now  turn  to  the  set  of  teeth  in  the  first  half 
of  tlie  flask,  remove  the  compound  and  scrape 
the  old  plate  to  get  a  new  surface ;  then  jjack  and 
vulcanize  as  usual.  But  leave  all  vulcanized 
cases  in  flask  for  several  hours  before  opening, 
if  possible. 

It  takes  time  as  well  as  cool  temperature  for 
vulcanized  rubber  to  crystallize  to  its  best — to 
"season."  Leave  case  in  flask  over  night  when 
you  can.  Quick  vulcanizing,  quick  cooling  and 
quick  removal  all  help  to  make  brittle  and  warj)- 
ing  plates;  don't  doubt  that. 

If  you  've  followed  instructions,  yoin"  ])late 
will  come  out  clean  and  nearly  flnished — no 
filing,  no  scraping,  no  grinding  of  teeth,  and 
little  polishing.  Remove  the  tinsfoil  with  a  thin 
amalgam  of  mercury  and  tin*foil,  or  tea*lead. 
made  in  your  hand  and  rubbed  on  with  your 
finger  or  a  Avad  of  cotton.  Xow  you  liave  a  fin- 
islied  refitted  lialf=soled"  denture. 

TO    REFIT    WITH    PLASTER    IMPRESSION — "PASS=WORD 
METHOD." 

If  you  wish  to  take  the  impression  in  plaster, 
you  simply  first  file  off  the  old  rim  and  heels  and 
add  compound,  and  very^edge  and  conform  and 
post^dam,  so  as  to  confine  the  plaster;  and  then 
take  it  according  to  the  "pass^word."  (Index 
P.)  Of  course  the  patient  will  bite  down  to  get 
the  impression,  instead  of  you  pushing  it  up  in 
her  mouth.      (Index  P.) 


IX   Dental   Prosthesis.  83 

COMMON,    OLD=FASHIONED    REFIT   OF   RUBBER   PLATES. 

But  if  you  want  to  make  merely  a  common, 
old=way  refit,  you  can  do  so  by  merely  taking 
the  impression  in  plaster  or  compound  alone, 
Avitliout  our  improvement  in  muscle  relief=with- 
out^leak  and  witliout  our  rim  and  heel  valvc' 
pressure  fitting. 

And  you  can  do  it  in  a  sort  of  approximate, 
halfsshod  ^vay  by  using  semi-licpiid  vidcanite 
paste  for  taking  the  impression.  But  these 
preparations  will  not  j^roperly  equalize  pressure 
even  on  difficult  plain  surfaces,  to  say  nothing  of 
their  utter  lack  in  muscle'trimming  and  valve* 
edge^pressure  (jualities.  so  essential  in  good  plate* 
work.  They  are  poor  substitutes  for  good  com- 
pound or  fine  plaster.  (Coarse  compound  and 
coarse,  stiff  plaster  won't  do  at  all.) 

Until  you  "get  your  hands  in"  by  a  little 
experience,  you  may  get  the  best  results  in  re- 
fitting by  using  impression  plaster  according  to 
tile  five  points  of  the  ''|)'i^^'^^'^^"^^-        (Index  P.) 

TO  REPRODUCE  PLATES  FROM  OLD  ONES. 

Yon  can  generally — in  fact,  nearly  always — 
get  a  few  more  dollars,  and  do  your  patient  more 
justice,  by  substituting  a  new  plate  in  place  of 
the  old  one,  instead  of  refitting  the  latter.  And 
it  '11  take  you  but  a  few  minutes  longer  and  cost 
you  but  a  few  cents  more. 

First  get  your  contract  to  refit,  and  go  on 
and  take  your  impression  for  that  purpose. 
Then  inform  j^atient  that  while  you  can  and 
will  be  responsible  for  the  jit,  you  can't  be  for 
the  breaking  of  the  ])late:  since  every  time  an 
old  plate  is  vulcanized  it  becomes  more  brittle 
and  more  liable  to  break  again.  But  you  11  put 
in   all  new  material  and  then   warrant  the  new 


84  Greexe   Brothers'  Clinical  Course 

plate  not  to  break.  (First-class  rubber  properly 
vulcanized  at  lowest  temperature,  long  time, 
against  tin=foil  or  gold=foil,  will  not  break.) 

A  ])atient,  after  you  have  begun  her  work, 
will  very  seldom  refuse  to  give  you  big  pay  for 
your  cjctra  few  minutes  in  making  her  a  new 
plate  instead  of  refitting  her  old  one. 

To  do  this,  you  do  just  what  I  have  de- 
scribed and  shown  you  in  refitting,  from  the 
first  to  last,  up  to  the  time  you  are  to  remove 
the  material  that  constituted  the  impression, 
ready  for  packing.  But,  instead  of  removing 
the  impression  material  and  scraping  a  new 
surface  on  the  old  plate,  you  just  remove  the 
whole  thing,  plate,  material  and  all,  and  pack 
for  an  entire  new  plate,  instead  of  for  a  lining. 

This  is  done  by  placing  the  half^flask.  con- 
taining the  set  teeth,  over  a  hot  flame  and 
heating  it  hot,  and  lifting  out  the  plate  from 
its  imbedment;  usually  teeth  and  all. 

As  you  lift  it  out,  some  of  the  plaster  around 
the  teeth  may  break  loose:  })ut  just  cement  the 
pieces  back  to  their  places  and  go  on. 

Heat  your  teeth  on  the  ])late  (after  oiling 
them  to  prevent  cracking)  by  pressing  them 
back  and  forth  over  a  small  spirit  flame,  and 
pull  'em  ofl"  in  the  usual  way.  Then  stick  each 
one  back  into  its  place  in  the  investment,  pay- 
ing no  attention  to  the  little  rubber  that  may 
remain  fast  to  the  pins — it  '11  do  no  harm. 

Pack  and  vulcanize  just  as  for  a  new  set  of 
teeth.  Then  you  have  made  a  new  j)late,  out= 
and*out,  with  no  more  work  and  but  a  few  cents 
more  cost  to  you  than  to  have  refitted  the  old 
rotten  one. 

But,  now,  bear  in  mind,  if  you  know  in  ad- 
vance that  you  're  going  to  renew  instead  of 
refit  the  case,  you  can  and  should  use  wax  in 


IX   Dextal   Prosthesis.  85 

changing  the  position  of  the  teeth  of  the  old 
plate  (before  taking  the  impression  therein),  in- 
stead of  packing  the  cracks  with  vulcanite,  as 
in  refitting. 

In  this  renewal,  if  the  old  plate  didn't  fit 
nor  the  teeth  set  right,  all  will  be  corrected 
together  in  the  new  plate. 

In  renewing  it  is  an  excellent  way  (in  occlu- 
sion correction),  to  take  the  teeth  all  off  of  the 
old  plate  and  set  them  back  into  their  several 
j^laces,  using  sticky  wax  in  their  re=adjustment. 

In  this  way  on  separating  the  flask  the  teeth 
will  remain  in  tlieir  embedment;  avoiding  the 
scaling  loose  of  plaster. 

Of  course,  you  will  adjust  over  the  ends  of 
the  teeth  the  new  invention,  Greene's  Oeelii- 
sion  Retainer,  before  the  first  investment;  this  to 
prevent  displacement  of  teeth  by  pressure  in 
packing  and  vulcanizing  and  to  avoid  after  grind- 
ing. ^ 

You  can  refit  or  renew  ])r()ken  plates  in  this 
way:  Fasten  the  two  or  more  pieces  together 
with  common  filling  cement  or  elsewise,  trim 
down  the  old  rim  and  take  the  impression  as 
I  have  shown  you,  either  in  "Perfection"  ma- 
terial, or  in  plaster  by  the  "pass-word"  way. 
Then  go  on  as  you  have  l)een  sliown.  If  you 
use  cement  to  fasten  the  pieces  together,  better 
strengthen  witli  ])ian()  wire  additionally. 

And  bear  in  mind,  in  all  these  repairs,  re- 
fittings  and  renewals  you  can  test  in  advance 
for  final  results,  the  same  as  in  testing  full 
impressions. 


86  Greexe  Brothers'  Clinical  Course 

THE  GREENE  READY=MADE,  NONCHANGEABLE  MODELS. 

To  make  sure  of  no  clmiige  from  your  test 
impression  by  faulty  plaster  models,  or  mal'Use 
of  even  o-ood  ones,  you  can  use  the  (treene 
ready-made  non=changeables  in  refitting  and  re- 
newing plates,  the  same  as  in  original  A^'ork. 
And  you  should  especially  use  them  if  you  tm-n 
your  work  over  to  ignorant  or  careless  assist- 
ants or  other  irresponsible  helpers. 

PRECAUTION  IN  REFITTING  AND  RENEWING  PLATES. 

X.  B. — ^^If  your  plate  is  thick,  scrape  it  down 
on  the  lingual  side  and  polish  it  before  having 
patient  take  her  impression;  else  you  may  get 
your  new  plate  too  thick.  Also  have  your  impres- 
sion material  soft  enough  that  the  old  plate 
may  show  through  it  at  places  for  the  same  reason 
just  given. 

Also  see  that  you  don't  get  too  much  rubber 
in  your  ])acking  and  that  you  have  ample  vents 
for  surplus,  to  prevent  over-strain  in  squeezing. 
To  prevent  getting  a  plate  thicker  than  your 
baseplate  use  the  Greene  Roof  Re-enfoveer  shown 
in  connection  with  the  Greene  Occlusion  Retainer, 
Better  always  use  the  cloth  plan  in  packing. 

Also  iliiuh;  if  you  fail  to  get  the  metal  edges 
of  flasks  together,  your  plate  will  ])e  corres]3ond- 
ingly  too  thick  and  the  teeth  that  much  too 
long  somewhere.  ^Nlost  of  the  ])oints  of  this 
lectiu'C,  now  closed,  will  be  further  illustrated, 
in  our  next  two  lectures,  in  their  application  to 
other  work. 


IX   Dextal   Prosthesis. 


LECTURE  NUMBER  TWO. 


LOWER  DENTURES. 


FIRST:  A  MODELING=COMPOUND  IMPRESSION  IN  DETAIL. 

AVell,  doctors,  we  now  come  to  what  gives 
more  trouble  to  dentists  generally  than  any  other 
part  of  i)late=work.  In  fact,  to  most  of  them  it  's 
the  most  difficult  of  all  dental  work.  That  is 
the  making  of  lower  full,  or  partial,  sets  of  teeth 
satisfactorily. 

In  this  clinic*lecture  we  '11  simpty  apply  the 
princi])les  laid  down  and  ex])lained  in  Section 
No.  1,  so  far  as  tliey  are  applicable.  With  these 
principles,  in  connection  with  others  especial  to 
lower  cases,  I  ho]:)e  to  show  you  that  it  is  as  simple 
and  easy  to  reach  satisfaction  in  difficult  lower 
cases  as  in  difficult  upper  ones. 

As  we  did  in  the  u})per,  so  we  '11  commence 
M'ith  a  modeling^compound  impression  and  a  full 
("double")  case. 

In  lower  cases  the  common  deep  and  long 
old  travs,  used  in  the  usual  old  ways,  are  even, 
if  possible,  more  absurd  than  in  upper  ones. 

Such  trays  being  longer  and  broader  and 
deeper  than  our  ex])ectant  denture  is  to  be,  you 
not  only  take  in  more  area  of  the  mouth  than 
is  needed,  but  generally  distort  the  ])arts  tlie 
plate  is  to  cover. 

Take  an  impression  of  a  distorted  mouth 
and,  of  course,  the  ])late  won't  fit  it  when  it 
resumes  its  normal  slia])e. 


88  Greene  Brothers'  Clinical  Course 

With  a  too  extensive  tray,  you  not  only 
press  the  soft  and  loose  tissues  out  of*  place, 
hut  you  strain  the  moving  muscles.  You  take 
the  impression  of  the  moving  muscles  when 
strained  down.  Then,  when  you  insert  the  re- 
sultant plate  on  them  icifhoiit  strain,  of  course 
tliey  rebound  and  lift  it  up. 

But  should  you  carefully  not  strain  some 
muscles  down  by  pressure,  but  mildlv  get  them  at 
normal  rest,  they  will  still  lift  up  above  the  nor- 
mal when  strained  in  biting  and  chewing".  (This 
is  a  new  thought  but  a  true  and  most  important 
one,  as  will  soon  be  demonstrated.) 

Then  you  diagnose  the  case  as  one  of  the 
"Johnny-.Tump-ups." 

Then  you  file  the  plate  off  by  guess  to  re- 
lieve the  muscular  strain,  when  it  turns  out,  in 
most  cases,  that  you  've  cut  off  too  much  and 
have  a  Icak^  as  well  as  a  relief.  What  is  needed 
is,  again,  ?'elief  without  leak. 

The  old  college  professor's  rule,  "Trim  your 
lower  plate  till  you  think  you  have  spoiled  it, 
and  then  trim  it  more  till  you  are  sure  you  have 
spoiled  it,"  is  a  grave  error,  to  put  it  mildly. 
Scores  of  them  seem  to  think  they  individually 
originated  the  "gag." 

Lower  plates  should  cover  all  the  territory 
compatibly  possible,  to  have  corresponding  areal 
contact  and  consequential  atmospheric  pressure, 
or  "suction."  The  less  areal  contact,  of  course, 
the  less  chance  for  atmospheric  push=down. 

The  fact  is,  the  very  contrary  of  the  "keep* 
on=trimming"  advice  is  true.  The  more  of  the 
ever-present  saliva  bed  that  is  covered  by  a 
lower  denture,  the  better  suction  it  will  have; 
provided  the  tissues  are  not  strained,  of  course. 
This  is  simply  self-evident  to  any  one  who  can 
reason  at  all. 


IX  Dextal  Prosthesis.  89 

But  this  matter  of  extension  and  limit  is  one 
to  be  dealt  with  an  hour  later  on.  For  the  pres- 
ent, we  want  to  take  a  lower  impression  of  the 
parts  in  their  normal  position,  and  without  undue 
strain  on  the  moving  muscles. 

In  some — in  fact,  many — cases,  we  must  un- 
avoidably cover  these  straining  tissues;  otherwise 
our  plate  would  be  so  "trimmed"  as  to  have  little 
or  nothing  left.  I  find  many  such  ones.  But  if 
we  have  a  system  it  must  cover  "ticklish  cases" 
and  all. 

Now,  to  take  an  impression  of  a  flexible  tis- 
sue with  room  for  reflex  action  is  the  problem. 

We  '11  illustrate  by  taking  it  first  in  a  way 
almost  sure  to  fail;  which  means  the  old  way  in 
common  use.  But,  first  of  all,  we  '11  find  and 
inspect  the  muscles  most  concerned. 

Xow,  each  one  of  you  place  your  right  in- 
dex finger  in  your  mouth,  left  side,  for  instance, 
as  far  back  as  you  can  get  it,  on  the  outside 
of  your  lower  teeth.  And,  as  you  press  down, 
open  and  ch)se  your  mouth,  and  especially  bite 
down  on  your  finger — several  times,  please. 

I  see  you  look  surprised,  for  you  know  what 
it  means,  ^'ou  cpiickly  anticipate  my  talk.  You 
have  learned,  before  I  tell  you,  just  wliat  ha])- 
pens  when  you  use  a  long,  broad-ended  metal 
tray  in  taking  an  impression  of  a  masseter  mus- 
cle and  its  coverings. 

You  take  it  in  a  relaxed,  at^rest,  or  even  a 
strained'down  condition.  When  you  open  and 
close  your  mouth,  and  especially  when  you  ])ite 
doicn  on  your  finger,  you  feel  what  irresistibly 
lifts  it.  It  lifts  u])  even  though  you  bear  down 
with  several  pounds'  pressure. 

Speaking  ])ractically  from  a  resistance  stand- 
point, you  can  and  do  take  a  lower  impression 


90  Greene   Brothers'  Clixical  Course 

in  this  way  (with  your  thiimhs)  at  many  pounds' 
strain=pressure. 

AVhile  you  dont  exactly  push  down  on  your 
extended  metal  tray  at  a  twenty  or  forty  pounds' 
strain,  you  do  take  that  part  of  the  impression 
in  a  way  to  give  the  masseter  muscle  and  its 
surroundings  so  much  capacity  to  lift  the  plate; 
and  they  use  as  much  of  the  capacity  as  is 
necessary  to  lift  it. 

These  figures  are  correctly  illustrative,  if  not 
exact. 

AVhy.  doctors,  I  see  some  of  you  are  so  hyp- 
notized with  concentrated  surprise  that  you  are 
still  holding  down:  down  on  the  main  muscle 
that  causes  so  many  of  your  lower  plates  to  have 
the  ' 'Johnnys j ump^ups. ' ' 

Xow,  how  are  you  going  to  take  an  impres- 
sion over  and  of  these  muscles  and  avoid  the 
jumps=ups  in  your  plate? 

Some  one  suggests  the  common  old  method 
of  "relief"  hy  cutting  away  the  denture  plate 
to  give  the  straining  tissues  room  to  move  in 
with  freedom. 

Yes.  if  you  tile  it  away  enough,  that  will 
relieve  it.  But  in  cutting  off  your  plate  short 
at  rear  ( or  even  at  side=rear ) ,  you  lose  the  most 
useful  and  most  effective  part  that  operates  to 
hold  it  down;  that  is,  the  most  effective  part 
when  it  is  properly  fitted  and  left  there. 

By  filing  it  off,  you  lose  not  only  just  so 
much  area  of  contact  for  atmospheric  pressure, 
but  lose  it  at  the  longest  and  most  powerful  end 
of  the  lever. 

The  farther  hack  a  plate  reaches,  the  longer 
your  lever  is:  and  the  more  surface  it  covers, 
the  greater  the  power  at  the  long  end  of  the 
lever.  This  is  sim})ly  mechanical  philosophy  that 
no    one    wi]l    gainsav:    assuming    tlie    fact    that 


IN   Dental   Prosthesis.  91 

the  front  teeth  constitute  the  fulcrum  in  tiie 
calculation. 

Assuming  there  is  no  under-push  upward, 
like  a  straining  tissue,  it  would  be  a  matter  of 
only  a  little  atmospheric,  or  other  weight,  to  i)re- 
vent  rear  tipping. 

If  the  plate  is  left  h)ng,  or  broad,  saliva  gets 
under  it  and  operates  like  water  between  two 
])ieces  of  glass,  wlien  they  "stick"  together — 
according  to  area  (jf  contact. 

Hence  the  mechanical  value  in  the  length  of 
a  lower  ])late.  But  tlie  condition  is.  there  must 
be  no  uplifthig  understrain  to  offset  the  atmo- 
spheric downspush,  of  course. 

TO  AVOID  STRAINING  THE  MUSCLES. 

Then  let  's  take  the  im])ression  in  tlie  first 
place,  so  as  not  to  strain  the  masseters,  or  other 
muscles. 

The  first  requisite  in  this  is  to  jit  the  tray 
to  the  mouth. 

We  '11  take,  if  need  be,  an  old,  soft=metal 
tray  and  with  curved  platesshears  cut  it  off  be- 
hind;  and  trim  it  down  in  front;  and  narrow 
the  sides;  until  it  is  even  shorter  at  rear,  and 
shallower  everywhere,  than  our  coming  finished 
plate  is  to  be;  cspccialli/  shorter  at  rear.  For 
we  don  't  want  it  to  run  back  onto  the  condyles, 
nor  onto  the  troublesome  masseters  at  their 
outer  sides.  If  we  sti-ain  things  about  the  con- 
dyle vicinity  with  ()nly  oui-  material,  we  can  cor- 
rect that.  And  it  is  only  a  correctable  impres- 
sion that  we  are  i)rei)aring  to  take. 

Besides  reducing  the  old  tray  in  length  and 
depth,  we  Ml  also  cut  its  handle  off  to  a])out 
three=quarters  of  an  inch;  then  thin  thai  down, 
so  as  to  reduce  overlapping  weight  and   avoid 


92  Greene   Brothers'  Clinical  Course 

ti2)ping.  Better  use  the  GreenesKerr  trays  that 
need  Uttle  cutting  down  and  no  cutting  off. 

A  long,  heavy  handle  to  a  lower  impression 
tray  is  about  as  useful  (and  about  as  much  in 
the  way)  as  a  rhinoceros's  horn=snout  would 
be  on  a  pet  pug's  face.  How  nicely  the  com- 
parative rhinoceros=horn  would  teeter  the  pup- 
py! And  how  vigorously  a  long,  heavy  handle 
would  teeter  a  lower  impression  when  you  let 
go  for  a  staysdown  test! 

And  yet  our  "best  men"  never  kick  to  go 
into  a  supply  house  and  find  none  but  horn* 
snout=laden  lower  impression  trays  in  the  well* 
filled  show-cases. 

The  metal  tray  should  fit  the  alveolar  ridge 
(or  over  where  it  used  to  be)  approximately 
well,  so  we  can  use  a  small  amount  of  impres- 
sion material. 

Such  a  tray,  with  minimum  contents,  is  a 
great  convenience  to  the  dentist  and  satisfac- 
tion to  the  patient.  All  told,  our  bulk  shouldn't 
be  twenty  per  cent  of  the  average  in  conmion 
practice,  by  old  methods. 

As  in  the  upper  case,  there  are  trco  tca?/s  of 
fitting  a  tray  to  a  loM^er  mouth. 

TJie  first  is  the  student's  way — a  good  way, 
too,  for  anybody. 

In  this  way,  with  a  m  e  d  i  u  m  tray  ("de- 
horned" over  masseter  region),  we  first  take 
a  hurried,  approximate  impression  in  modeling 
compound,  and  cool  it  somewhat  in  the  mouth 
with  cold  water,  thrown  in  with  a  piston  syringe. 
Tlien,  with  quickening  salt,  or  better,  sulphate 
of  potash,  make  a  hiu'ried,  approximate  plaster 
model.  Then  with  the  thumb  and  fingers,  or 
pliers,  bend  the  tray  to  fit  it  approximately, 
turning  the  heels  of  the  tray  up  a  very  little, 
to  prevent  metallic  rear*gouging. 


IX  Dental   Prosthesis. 


93 


LOWER  TRAYS. 


Fig.   10. — Absurdity. 
Too  large  for  any  nioutli. 


For   large    ridge. 
Fia'.   n. — Co.-\iPROMisK. 


Fig.   12." — Reason.vhi.k. 
For    niediuin    size. 


[These  cuts  represent  three- f on rllis  of   full   size  of  lower  trays.] 


94  Greexe  Brothers"  Clinical  Course 

The  second  is  the  practitioner's  way — which 
is  quicker,  but  less  accurate;  but  usually  good 
enough.  This  is  to  get  right  in  front  of  the 
patient's  face,  and  with  the  right  hand  enter 
the  right  wing  of  the  tray  into  the  mouth,  as 
a  farmer  does  the  rails  of  his  "bars"  (gate). 
Then  let  go  of  the  handle,  and  with  both  in- 
dex lingers  spread  the  lips  a  little  and  look  in. 

If  we  let  go,  the  tray  will  drop  down  and 
center  itself  over  the  ridge,  or  place  of  the 
ridge,  by  cheek  and  tongue  guidance  and  its 
own  weight. 

We  11  examine  its  needs  and  take  it  out 
and  expand  or  contract  its  wings,  and  turn 
its  heels  up  or  down  till  it  approximately  fits 
the  jaw. 

>s"e\'er  attempt  to  hold  the  tray  down  in 
place  to  inspect  it,  but  let  it  seek  its  own  po- 
sition, freed  from  cheek=and=lip  hindrance. 

The  next  step,  after  fitting  the  tray  by 
either  method,  is  to 

TAKE  A  CORRECTABLE  IMPRESSION. 

By  "correctable"  I  mean  one  where  no  part 
of  the  metal  comes  in  contact  with  the  tissues 
of  the  mouth.  We  are  going  to  correct  up  this 
impression  by  mouth  and  tongue  movements 
on  sensitized  surfaces;  but  we  couldn't  thus 
correct  a  metal  tray. 

Students  and  novice  practitioners  are  ad- 
vised to  take  this  correctable  impression  from 
the  approximate  model  that  they  first  fitted  the 
tray  to;  then  afterwards  fit  it  to  the  mouth, 
as  now  soon  to  be  described. 

To  take  the  correctable  impression  from 
the  approximate  model  is  very  simple.  First 
rub  the  model  well  witli  pulverized  soapstone. 
Then  make  a  little  roll  of  warm  modeling  com- 


IX   Dextal   Prosthesis.  95 

pound  in  your  hands  and  press  it  carefully  down 
onto  the  prepared  model.  Then  press  the  fitted 
tray  down  onto  the  compoimd. 

^V'hile  we  finger=})ress  the  compound  around 
the  edges  of  the  tray  to  the  model,  we  '11  not 
forget  to  turn  a  little  of  it  over  onto  tlie  hack, 
or  reverse  side,  of  the  tray,  and  touch  it  with 
our  finger,  dipped  in  cold  water,  to  clinch  the 
tray  and  compound  together. 

We  have  here  now  taken  a  correctahle  im- 
pression of  the  approximate  model;  the  next 
thing  is  to  separate  them.  We  must  begin  the 
separation  hefore  the  impression  material  gets 
anytliing  like  hard.  And  right  here  is  where 
some  of  the  class  may  get  things  mixed  up  a 
little.     Watch  close  and  listen  carefulh/! 

AVhile  yet  ^\•arm,  we  '11  dip  the  whole  thing 
into  cool  water  for  a  reri/  fete  seconds,  to  chill 
the  imju-ession  a  little.  Xo.  we  '11  take  it  out 
and  (|uickly  pull  it  parthj  loose  from  the  model 
at  tile  heel:  liurriedly  re=dip  it  back  to  let  the 
cool  water  under  it;  jerk  it  out  and  instantly 
re^press  it  back  tightUi  to  the  model;  and  stick 
it  ])ack  to  ///////  cool.  After  cooling,  we  "11  sep- 
arate carefully. 

If  we  at  first  let  the  compound  cool  fully 
without  this  precaution,  we  might  find  the  sep- 
aration more  difficult  in  some  cases. 

And  there  are  a  few  instances  where  we  have 
to  "core  out"  underscuts  before  taking  an  im- 
pression of  a  mold.  In  this,  we  simply  first 
fill  u])  the  under^cut  with  compovmd,  and  cover 
it  with  tin*foil,  and  soapstone  the  foil;  then 
go  on  and  take  the  impression  as  I  've  just 
described. 

Doctors,  he  sure  you  understand  me  in  sep- 
arating an   impression  from  a  model,  when  we 


96  Greene  Brothers'  Clinical  Course 

wish  to  preserve  the  mipression,  as  we  do  in 
this  instance. 

Don't  attempt  to  take  an  impression  of  a 
model  without  first  soapstoning,  or  otherwise 
creating-  it,  to  prevent  adliesion ;  and  then  don't 
get  your  compound  too  warm — never  hot. 

AVe  now  have  a  correctable  impression  from 
the  approximate  model  (student's  way);  and 
are  ready  to  adjust  it  to  the  mouth,  in  all  its 
parts  and  points  and  details — ^^soon  to  be  shown. 

But,  before  we  show  you  liow  to  correct  and 
adjust  a  student's  correctable  impression  to  the 
mouth,  we  must  return  to  the  practitioner's 
method  and  show  you  how  we  get  said  impres- 
sion directly  from  the  mouth.  The  corrections, 
after  taken,  are  similar  in  both  methods. 

The  practitioner's  May  is  the  shorter  one. 
but  not  as  simple  nor  as  easy  as  to  take  it  from 
the  approximate  model,  outside  of  the  mouth. 
And,  only  for  the  inconsiderable  extra  ten  min- 
utes for  taking  the  student's  approximate  im- 
pression and  making  the  approximate  model 
from  it,  I  'd  always  prefer  the  round-about  way 
of  getting  the  correctable  impression. 

I  have  learned,  mostly,  to  disregard  a  few 
extra  minutes  of  work,  for  convenience,  com- 
fort, better  results,  and  avoidance  of  future  an- 
noyance; especially  in  difficult  cases. 

PRACTITIONER'S   CORRECTABLE  LOWER  IMPRESSION. 

Our  metal  tray  has  been  fitted  to  the  mouth. 
(Index  F.)  Now  we  '11  take  a  small  hand-made 
roll  of  wai"m  c()ni])()nn(l — for  a  medium  case, 
about  one==foin'th  inch  in  diameter — and  place 
it  onto,  or  into,  the  face  of  the  prepared  tray. 
(Tray  should  have  some  small  holes  through 
it,  to  help  fasten  the  impression  to  it.) 


IX   Dextal   Prosthesis.  97 

The  roll  is  purposely  an  inch  or  more  too 
long;  so  we  '11  double  the  length^surplus  over 
onto  the  back,  or  reverse  side,  of  the  tray, 
press  closely,  and  finger-touch  it  with  cool  wa- 
ter, to  prevent  its  dropping  loose  when  we  turn 
it  over  to  take  the  impression  in  the  mouth. 

The  impression  material  being  fastened  to 
the  tray  and  finger* fashioned  ready  for  appli- 
cation, we  now  further  warm  it  till  quite  soft, 
by  x^assing  it  l)ack  and  forth  over  our  hand-lamp 
flame. 

Before  entering  it  into  the  mouth,  we  '11 
look  the  i^atient  straight  in  the  face  and  say: 
"Madam,  this  is  warm,  but  don't  fear;  it  \\ill 
not  burn  you."  This  forewarning  is  often  nec- 
essary to  forestall  a  false  suggestion  of  pain. 
Form  you  a  habit  of  forestalling  suggestion,  and 
save  both  yourself  and  patient  annoyance  and 
trouble. 

And  let  this  suggestion  include  the  gratify- 
ing fact  that  you  '11  not  choke  her — a  popular 
fear  of  impression^takings. 

We  are  standing,  or  sitting,  right  in  front 
of  our  patient,  who  is  seated,  preferably,  in  a 
common  chair  and  in  our  impression^room,  or 
cli'fui  laboratory.  Our  small  alcohobgas  water- 
heater  and  all  the  rest  of  our  needed  conveni- 
ences are  on  our  little  table  witli  cleats  around 
its  edge  to  pre\ent  things  from  slipping  off. 

This  little  impressionstable,  with  its  contents, 
is  at  our  right  liand  and  within  easy  reach. 

AVith  our  ])atient  sitting  up  straight  and 
liead  in  natural  position,  we  hold  our  loaded 
tray  by  its  short  handle  between  our  thumb 
and  finger  (right  hand)  and  enter  first  the  right- 
hand  wing  into  the  mouth;  tlien  push  it  to  the 
right  and  enter  the  left  wing. 


171 


98  Greexe   Brothers'  Clinical  Course 

As  soon  as  both  Avings  are  well  in,  we  '11 
let  go  and  instantUi  spread  the  cheek-lips  a  lit- 
tle with  our  index  fingers,  both  hands;  that  is, 
we  '11  pull  forward  a  little  and  spread  lightly. 

Xow,  right  here,  doctors,  let  nie,  even  in  ad- 
vance, caution  you  not  to  make  this  lip-spread- 
ing  "stunt"  too  roughly — as  you  '11  be  apt  to 
do.  Practice  it  first  on  each  other's  mouths, 
take  your   scolding  kindly,   and  profit   thereby. 

This  light  spread*shaking  of  the  lip=cheeks 
gives  room,  and  our  tray  centers  and  settles 
down  instantly,  of  its  own  weight,  guided  by 
the  tongue  and  cheeks,  to  its  proper  place. 

It  is  in  position.  Standing,  or  sitting  (I  re- 
peat), right  in  front  of  my  patient,  I  quicklij 
place  my  two  index  fingers  on  the  wings  of  my 
tray  and  ^vave=press  down  gently  and  lightly: 
ahcai/s  Ughtlij. 

(I  expect  to  repeat  several  times  in  this 
Course  that  an  impression  should  be  taken  at 
about  the  strain  the  plate  is  to  be  worn.  A 
little  reflection  will  tell  you  why.) 

When  it  's  down  to  place.  I  hold  it  there  a 
few  seconds  to  chill  a  very  little.  Xow  watch 
close  while  I  press  the  sides  of  my  impression 
to  place.  I  lay  my  left  index  finger  on  top  of 
the  left  wing  of  my  tray  longitudinally — not 
c?'oss'wise.  At  the  same  moment  I  ])ut  my  left 
thumb  under  the  handle — or,  rather,  lip — of  the 
tray,  to  steady  it,  if  needs  be. 

While  I  thus  hold  the  impression  down  with 
my  left  index  finger,  I  run  my  right  index  fin- 
ger around  on  the  lingual  side  (under  the  left 
side  of  the  tongue)  and  press  the  soft,  projecting 
compound  under  the  edge  of  the  tray,  and  back 
behind  it,  onto  the  condyle,  and  on  the  outside 
of  it,  over  the  masseter  muscle — ^^well,  all  around 
the  condyle  lightly. 


IX   Dental   Pkosthesis.  99 

Now,  change  hands,  and  in  exactly  the  same 
way  do  exactly  likewise  on  the  left  side.  Get 
this  all  clear  in  niind;  then  we  '11  go  ahead. 
(Some  one  of  the  class  is  asked  to  explam  this 
far;  then  we  resume.) 

I  '11  now  hold  the  impression  down  ^^■ith  my 
two  index  fingers,  one  on  each  side;  and,  wliile 
doing  so,  I'll  straddle  the  cheek=lips  (on  both 
sides  of  the  mouth)  so  as  to  get  the  cheek  be- 
tween my  indcw  finger  and  my  long  nei.vt,  "mid- 
dle," one. 

Observe  closely:  my  jirst  fingers  are  on  the 
inside  of  the  mouth,  holding  down  the  tray,  and 
my  second  fingers  are  on  the  outside  thereof. 
While  I  work  down  on  the  cheek,  outside,  with 
my  long  fingers,  I  also  at  the  same  time  work 
down  the  outside  of  the  under^lip,  in  front, 
with  my  tliumbs.  Why.  it  seems  as  though 
our  hands  and  fingers  were  made  on  purpose 
to  take  a  lower  impression  in  this  simple,  easy 
"Greene"  way. 

Now,  my  impression  is  pressed  down  to  place 
all  around,  on  both  inner  and  outer  sides  of  the 
alveolar  ridge,  and  also  at  the  heels.  But  it 
presses  too  hard,  probably,  on  the  active  mus- 
cles, especially  the  masseters. 

And  now,  here,  doctors,  is  a  pointer  of  great 
value  to  any  extensive  ])late=maker.  A\'ith  my 
front  finger  still  holding  the  impression  down, 
and  the  modeling  compound  still  warm,  I  saj^: 
"]Madam.  o])en  and  close  your  mouth  and  bite 
down  on  my  fingers,  quickli/:"  As  I  gi\'e  her 
the  command,  I  look  her  in  the  face  and  kind 
o'  obey  it  myself,  to  ])r()m))t  lier  movement. 

When  she  opens  and  closes  her  moutli  and 
bites  on  my  finger,  the  muscles  aforesaid  lift 
the  material,  projecting  beyond  the  metal  tray, 
up  enough  to  give  full  relief  from  maximum 
strain,  but  no  more.  The  contact  is  still 
enough  that   tlie  little  space   between   the  lifted 


100  Greene  Brothers'  Clinical  Course 

compound  and  the  flesh  (niaximmn  and  min- 
imum range  of  play)  will  fill  up  with  saliva,  and 
thus  make  conditions  for  atmospheric  pressure, 
or  so-called  "suction." 

After  she  has  obeyed  mj^  command  and  the 
strain  is  lifted  from  the  masseters  and  condyles, 
with  my  fingers  still  on  downsholding  duty,  I 
have  her  also  work  her  lip  and  cheeks  a  little, 
to  approximately  relieve,  maybe,  other  strained 
tissues;  especially  the  levator  labii  inferioris. 

Then  I  give  her  another  command  (  for  which 
she  has  previously  been  prepared,  and  instruct- 
ed to  obey  it)  :  "31adam,  now  squirt  your  cold 
M'ater  into  your  mouth  quickly!"  This  is  from 
a  httle  syringe  in  her  own  hand;  or  in  the  hand 
of  an  assistant,  if  one  is  at  command.  It  is  to 
cool  the  imjDression. 

After  a  half^minute's  cooling  I  remove  my 
correctable  impression  from  the  mouth;  and 
the  whole  procedure  hasn't  taken  much,  if  any, 
more  than  a  minute  or  two  of  time. 

But  ^ye  '11  look  at  it  now,  and  see  whether 
it  is  really  a  correctable  impression  or  not.  If, 
by  some  mishap,  the  metal  edge,  or  other  part 
of  the  tray,  should  show  through,  it  'd  not  be 
a  correctable  impression.  The  movements  of 
the  muscles  can't  correct  metal. 

So,  if  any  metal  is  in  sight,  we  '11  just  cut 
it  all  away  with  knife  or  file  sufficiently,  and 
trace  compound  thereonto;  then  it  will  be  cor- 
rectable, by  muscle=trimming. 

Well,  we  now  have  about  what  we  'd  have 
had  by  the  student's  method,  plus  the  approx- 
imate relief  of  masseters,  just  described.  In 
either  case,  we  are  now  ready  to  proceed  to 
correct  what,  after  all,  is  so  far  only  a  model- 
ing'compound  tray.     The  correction  will  be  the 


IX   Dental   Prosthesis.  101 

transformation  of  this   tray,   bj^   detail,   into   a 
test^impression. 

You  have  now  seen  done  and  heard  ex- 
plained the  first  step  in  a  full  lower  modeling* 
compomid  impression.  To  further  impress  it 
on  your  minds,  some  one  of  you  may  now  read 
it  as  "Step  No.  1,"  on  this  hst  of  printed  notes, 
that  each  one  of  the  class  is  to  keep  for  future 
reference.  (Later:  This  imntccl  work  will  now, 
of  course,  supersede  the  former  note  system  for 
reference. ) 

STEP   NO.  2   IN  LOWER  IMPRESSION. 

"Trim  it  approximately  tcith  knife,  leaving 
it  a  little  too  long,  and  fully  deep." 

This  consists  simply  of  the  warming  of  the 
edges  a  little  over  the  s))irit'lamp  and  shaving 
off,  with  a  sharp  knife,  what  is  evidently  a 
surplus. 

Bear  in  mind,  this  knifestrimming  is  only 
a  crude  approximation;  but  about  such  as  dent- 
ists usually  depend  on  for  exactness  in  the  com- 
mon, old  method  of  guess^trimming  of  plates. 

Well,  now  that  our  correctable  impression 
is  only  a  very  little  larger  than  the  finished 
plate  is  to  be,  and  will  not  distort  the  mouth 
hy  its  size,  or  depth,  or  length,  we  are  ready 
to  correct  its  center  over  the  alveolar  ridge; 
or  where  the  ridge  used  to  be,  if  absorbed. 

It  may  really  be  correct  there  now,  but  we 
don't  know  it;  for  it  covered  more  area  than 
we  needed,  and  that  may  have  strained  and 
distorted  what  we  do  need.  So  we  '11  go  through 
the  motion,  and  no  harm  ^\ill  be  done,  anyhow. 

STEP  NO.  3  IN  LOWER  IMPRESSION. 

''Equalize  the  center  by  hot-stream,  normal 
plate^ pressure,  and  icave'like  motion/' 


102  Greene  Brothers'  Clinical  Course 

We  '11  pour  our  tenspenny  hot=stream  from 
our  little  spout=eup  into  its  center  till  it  is  quite 
soft — just  on  the  safe  side  of  the  burningspoint» 
This  softens  the  center  well  and  deeply. 

Then  instantly  ^^e  dip  the  whole  tiling  into 
hot  water  and  out  quichly,  to  mellow  the  edges  a 
little,  but  very  shallowly.  Then  dextrouslj^  but 
carefully,  return  it  into  the  mouth  (left  side  of 
mouth  first)  and  as  quickly  wave*press  down 
with  our  two  index  fingers  lightly. 

We  hold  it  down  half  a  minute,  when,  more 
than  nine  chances  to  one,  the  pressure  is  equal- 
ized; if,  indeed,  it  needed  equalizing.  But  do 
this  properly  a  second  time,  and  it  is  sure  to 
be — =which  is  to  be  test=proven  a  little  later  on. 

Of  course  all  this  has  to  be  done  quickly, 
or  it  will  be  a  failure.  It  may  take  some  prac- 
tice for  some  of  you  to  do  it  quickly  enough 
for  success.  As  in  writing,  you  first  learn  hoxo 
to  perform  these  little  manipulations  and  then 
how  to  do  it  speedily. 

One  "D.D.S.,"  with  a  sigh,  once  upon  a  time 
voluntarily  admitted  he  "wa'n't  jitten  by  na- 
tur  to  do  sich  fine  work  and  so  quick."  He'd 
"ruther  practus  his  specialty  an'  pull  an'  plug 
teeth  an'  do  crown*  an'  bridge- work."  Ha,  ha, 
ha!! 

Well,  now,  you  may  read  your  note  again, 
as  before,  what  you  have  seen  done  and  heard 
explained,  as  the  third  step. 

I  '11  only  add  that,  if  we  took  our  correct- 
able impression  by  the  practitioner's  method, 
and  carefully,  it  isn't  probable  any  change  has 
been  made  as  to  the  fit  by  this  equalizing  step. 
But,  if  any  at  all,  it  isn't  probably  more  than 
the  thickness  of  the  thinnest  blotting*paper,  at 
the  most.    An  expert  can  do  this  by  quick  hot^^ 


IN   Dental   Prosthesis.  103 

dipping  the  whole  impression,  instead  of  spout* 
cup  pouring. 

STEP  NO.  4  IN  LOWER  IMPRESSION. 

''Bite  on  dummies,  for  jaw'rest" 

We  will  now  prepare  to  very*edge  the  outer 
rim  of  our  impression.  As  before,  this  muscle' 
trimming  is  done,  again,  by  lip'and==cheek  and 
tongue  movement,  on  sensitized  surfaces. 

To  very-edge  correctl}',  and  hence  success- 
fully, the  impression  must  surely  be  held  down 
to  place  while  the  muscles  do  their  trimming. 
This  is  absolutely  essential;  so  we  must  plan 
to  hold  it  down.  And  it  must  be  down  with- 
out our  own,  or  our  patient's,  finger=help;  for 
that  would  interfere  with  the  normal  action  of 
the  moving  tissues  that  do  the  trimming.  In- 
deed, the  patient  wouldn't  make  the  necessary 
movement  with  my  finger  in  her  mouth. 

So  we  '11  put  a  jaw^rest  on  the  reverse  side 
of  the  metal  tray  for  her  to  bite  down  onto, 
while  she  makes  the  scientific,  automatic,  self' 
trimming  movements. 

See!  I  will  take  this  little  roll  of  warm 
compound,  about  three=fourtlis  of  an  inch  long, 
heat  its  surface  on  one  side  a  little,  and  stick 
it  onto  my  metal  tray — the  other  side  from 
the  im])ression.  I  '11  i)ut  one  on  each  side,  of 
course.  They  are  "dummies."  I  '11  warm  the 
edges  of  my  dummies. 

"Xow,  Madam:  When  I  put  tliis  into  your 
mouth,  I  want  you  to  })ite  dowii  onto  it  quick- 
ly/' She  gives  one  snap  and  my  dummies  have 
the  marks  of  tlie  u])])er  teeth  ((n-  her  gums,  if 
slie  has  no  teetli)  on  tliem.  That  is,  we  have 
had  her  "bite  on  dummies  for  jawiTst." 

So  you  now  read  "Step  Xo.  4."  after  you  've 
seen  it  done  or  heard  it  all  exj)laine(l  in  detail. 


104  Greene  Brothers'  Clinical  Course 

STEP  NO.  5  IN  LOWER  IMPRESSION. 

'^Vcry-cdgc  (musclc'trim)  outer  rim  and  Jicels, 
one  side  at  a  time,  by  szcalloicing  and  lip'and- 
cheek  movements,  ichde  biting  dozen  on  dum- 
mies." 

I  ^vill,  for  instance,  very-edge  on  the  left 
side  of  her  face  first.  I  '11  warm  the  very  edge 
of  what  is  the  right  Aving  of  the  impression 
when  the  handle  jjoints  toward  me,  and  slip 
the  opposite  left  wing  (not  warmed)  into  her 
mouth  first;  then  pull  lier  left  cheek  over  to 
her  leftward,  and  enter  the  warmed  edge  last, 
without  cheek  interference. 

Immediately  she  bites  down  onto  the  jaw» 
rest  (dummy)  and  swallows,  and  sucks  her 
cheeks  and  works  them  energetically.  In  from 
fifteen  to  thirty  seconds  I  have  the  outer  side 
of  my  impression  accurately  trimmed,  and  also 
cut  ofi^ — ^^or,  rather,  turned  up — for  the  right 
length  at  rear. 

The  deglutitory  motion  did  the  up=turning 
for  the  length  of  the  coming  plate.  And  it  will 
be  just  this  long,  because  the  model  from  our 
up'turned  lieel  will  make  it  just  so.  The  length 
of  a  lower  plate,  same  as  that  of  an  upper  one, 
may  be  of  exceeding  importance. 

But,  lest  this  first  trimming  may  possibly 
not  be  all  that  is  needed,  I  '11  repeat  it  till  no 
further  show  is  made  by  the  cheek  and  swal- 
lowing movements.  Do  this  righth%  and  j^our 
trimming  will  be  exactly  correct. 

Now,  I  '11  similarly  warm  the  other  side  and 
oppositely  enter  it,  and  have  the  same  move- 
ment made  as  before.  And,  if  necessary,  I  '11 
make  a  special  trip  into  the  mouth  to  partic- 
ularly muscle-trim  the  lower  lip-strain  by  the 
movement  of  the  levator  labii  inferior  is — in  Latin 
for  short ! 


IX  Dextal  Prosthesis.  105 

You  well  know  how  commonly  this  levator 
hreeds  the  Johnnv'jmnp^up  malady  in  lower 
dentures.  But  this  pesky  lever  is  a  wise  me- 
chanical surgeon;  it  knows  just  where  to  trim 
a  modelingscompound  impression,  or  plate,  if  it 
has  a  chance. 

Well,  we  are  done  with  the  outer  rim;  let  's 
get  to  tlie  inner  one. 

STEP  NO.  6  IN  LOWER  IMPRESSION. 

In  the  language  of  youY  printed  note,  let  us 

"Very  -  edge  the  inner  rim  and  inner  heels, 
all  around  at  once,  by  sicalloicing  and  by  vig- 
orous tongue  movements,  while  biting  dozen  on 
dummies  f' 

Since  we  are  getting  onto  our  job  of  sci- 
entific trinmiing,  this  is  easy. 

I  will  this  time  warm  the  inner,  or  lingual, 
rim,  and  all  around  at  the  same  time.  But,  as 
the  muscles  and  glands  under  the  tongue,  that 
are  to  do  the  mechanical  surgery,  are  often  Yerx 
lax  and  soft  and  weak,  we  must  now  have  our 
inner  rim  quite  soft  indeed — ^just  a  few  degrees 
on  the  cooler  side  of  the  scorching-point,  in 
some  cases. 

After  blistering  your  o^^n  mouth,  and  es- 
pecially that  of  your  patient  mother^iu'law  a 
few  times,  you  '11  learn  to  make  this  fine  line 
of  thermal  demarkation  to  an  amazing  nicety. 
(Don't  shudder  at  this  prospect  of  vivisection 
in  the  interest  of  prosthetic  dental  science.) 

You  must  learn  to  musclestrim  the  lingual 
rim  so  it  will  safely  set  down,  without  strain,  in- 
to the  su])=lingual  saliva  pool,  to  give  it  suction. 

To  my  patient:  "listen,  ^ladam,  to  what 
I  'm  going  to  say.  The  instant  I  slij)  this  edge^ 
warmed  impression  into  your  moutli.  I  want 
vou  to  bite  down  on  our  dummies  and  szcallotv. 


106  Greene  Brothers'  Clinical  Course 

and  throw  your  tongue  all  over  your  mouth  as 
vigorously  as  you  can.  Act  quickly  and  fast!" 
(Better,  in  some  cases  practice  jNIadam  a  little, 
in  advance,  in  the  movement.) 

She  has  obeyed;  we  '11  leave  the  impression 
in  a  few  seconds  to  cool  and  then  take  it  out 
and  knifestrim  off  the  turned=up  edge,  or  a  part 
of  it.  We  '11  use  common  sense  and  simply 
repeat  what  we  have  done  till  no  more  sur- 
plus turns  up  by  the  same  energetic  action; 
then  we  '11  have  an  accuracy  of  trimming  not 
to  be  reached  in  an  hour,  or  a  day,  of  trials  by 
guess  ^trimming  off  a  plate  after  it  's  made. 

You  say:  "All  this  is  migthy  particular 
work."  Of  course  it  is;  but,  after  all,  not  more 
so  than  many  other  things  you  liave  been  do- 
ing. Xor  is  it  as  particular  as  what  your  wife 
has  often  to  do  when  she  picks  the  naughty 
motes  from  your  eyes. 

Can  you  afford  to  be  as  skillful  and  as  art- 
istic in  your  boasted  j^rofessional  manipulation 
as  your  chiropodistic  artist  has  to  be?  If  not, 
better  turn  your  impression=taking  over  to  him. 
He  is  used  to  being  "particular"  in  Jiis  work. 
But,  seriouslj^  it  will  not  seem  to  be  so  when 
you  get  accustomed  to  it. 

STEP  NO.  7  IN  LOWER  IMPRESSION. 

''Conform  lingual  side  hi/  steady  tongue'press- 
nrc,  and  cool  well  in  place,  rcith  si/rin^-e,  through 
7iotch,  rchile  biting  down  on  dummies/' 

By  conforming,  you  know,  we  mean  warm- 
ing slightly  and  pu.shing  to  place  with  steady, 
gentle  pressure,  and  cooling  while  under  such 
pressure.  To  press^to  and  then  remove  and  let 
the  material  rebound  wouldn't  be  conforming 
worth  a  penny. 


IX   Dextal   Prosthesis.  107 

It  must  be  at  least  fairly  well  chilled  Avhile 
in  place,  under  gentle  strain,  and  then  well 
cooled  before  removal.  Don't  tire  of  this  repe- 
tition; you  11  "need  it  in  j^our  business." 

But  let  us  go  on  and  conform  these  lingual 
sides  of  our  impression.  In  our  sub  '  lingual 
verj^sedging  we  prevented  air  from  passing  in 
and  out  under  the  lingual  edge,  by  its  reaching 
onto  and  into  the  sub'lingual  saliva  pond.  But 
there  is  room  for  some,  and  is  already  some, 
behind  it.  So  we  must  get  that  out;  or,  rather, 
we  must  have  our  patient  do  it. 

Before  we  put  her  at  it,  we  '11  cut  a  little 
notch  in  the  dummy,  on  the  left  side  of  her 
face,  so  we  can  squirt  some  cold  water  under 
her  tongiie,  through  our  syringe  point,  to  cool 
the  compound,  while  under  pressure. 

I  repeat:  "Xoiv,  Madam,  listen  to  ichat  I'm 
going  to  ask  you  to  do.  As  soon  as  I  place  this 
into  your  mouth,  I  Mant  you  to  push  it  up 
close  against  your  gums  with  your  tongue,  using 
gentle,  steady  pressure.  Push  all  around  and 
hold  it  to  place  till  I  can  scjuirt  some  cold  wa- 
ter through  this  notch  and  thoroughly  cool  it." 

This  she  will  easily  and  readily  do.  Her  soft 
tongue  will  give  an  even,  equalized  pressure  on 
the  harder  and  the  softer  parts,  nearly  the  same. 

I  will  here  remind  you  that  we  are  now  tak- 
ing this  part,  as  we  have  taken  all  other  parts, 
at  about  rightsangle  pressure;  which  is  almost 
essential    in    modeling^compound    manipulation. 

Plaster  of  Paris  (by  the  '"pass^word  method" 
only)  pushes  in  all  directions  alike,  and  thereby 
equalizes.  But  modeling  composition — the  best 
of  it — ^^liasn't  nmch  flowing  quality,  at  a  suffer- 
able  temperature;  therefore  it  must  be  pressed 
at  right  angle  against  tlie  soft  places,  which 
yield  according  to  their  needs. 


108  Greene  Brothers'  Clinical  Course 

All  right;  we  've  now  so  pressed  the  lingual 
side  of  our  impression  and  cooled  it  through 
the  prepared  notch.  Xow,  we  have  valvC' 
pressure  on  all  the  soft  parts,  so  air  can  not 
pass,  unless  our  impression  (or  plate)  is  moved 
by  force;  and  this  common  force  has  been 
prevented  by  muscle=trimming. 

We  have  here  done  a  most  important  thing 
in  making  a  lower  plate — 'Conformed  it  to  the 
lingual  side  of  the  alveolar  ridge,  assuming  it 
has  a  ridge. 

STEP  NO.  8  IN  LOWER  IMPRESSION. 

"Take  impression  of  fraenum  by  quick  Up' 
licking,  and  re'touch  "while  holding  down  with 
both  index  fingers.  Dont  bear  hard  nor  press 
downward  when  re'touching." 

Just  before  warming  the  spot  of  fraenum 
contact  on  the  lingual  rim  of  my  impression, 
at  the  side  of  my  small  spirit'flame,  or  with  my 
mouth  blowspipe,  I  say:  "Mrs.  Jones,  I  'm  go- 
ing to  hold  this  impression  do^vn  myself  this 
time,  with  my  forefingers,  so  you  can  use  your 
tongue  quickly  and  freely.  Immediately  on  this 
going  back  into  your  mouth,  you  will  please 
lick  up  under  your  upper  lip  vigorousty,  and 
quickly  draw  your  tongue  back   to  its   place." 

In  doing  this,  when  the  material  is  quite 
soft,  she  simply  muscle=trims  out  room  for  the 
fraenum  to  move  freely  in,  when  she  licks  her 
lips,  in  wearing  the  plate.  For,  of  course,  again, 
the  plate  is  to  be  a  duplicate  of  the  impression. 

But,  as  she  may  trim  out  a  little  ioo  much, 
so  as  to  leave  a  little  leak  (at  the  sides  of  the 
frsnum) ,  I  hurriedly  dip  my  finger  in  cold  wa- 
ter, and  reach  over  under  her  tongue,  and  gen- 
tly   pull    back   what   may   have   been   overdone 


IN  Dental  Prosthesis.  109 

by  the  muscle  itself  under  too  vigorous  tongue 
movement.  She  musn't  loll  her  tongue  out, 
lest  she  fr^numizes  too  deeply  and  gives  relief 
xiith  a  leak. 

I  will  here  give  you  each  a  sample  retouch 
in  your  own  mouths,  using  a  different  finger, 
of  course,  in  each  case.  You  feel  my  finger 
pressure  is  light,  but  steady  and  not  downward. 

Should  you  use  much  force  in  retouching, 
you  'd  undo  what  you  've  aimed  to  do.  You 
merely  need  to  pull  back  to  place  a  "leetlc" 
compound  that  may  have  been  pushed  off  from 
the  ridge  at  the  sides  of  the  frsenum,  so  as  to 
stop  the  air^leak. 

STEP  NO.  9  IN  LOWER  IMPRESSION. 

Here  is  j^our  note : 

''Test  for  fit.  Dip  the  impression  in  cold  wa- 
ter; place  it  in  the  mouth;  and  hear  down  with 
index  fingers  firmly  for  half  a  minute.  If  it 
sucks  fast,  or  even  if  it  comes  loose  with  a  little 
noise,  it  's  O.  K. — not  otherwise.  If  no  blunders 
are  made  in  following  up  all  after-work,  the  plate, 
after  it  settles,  will  always  fit  even  better  than  the 
impression  tests." 

Any  perfect  impression,  on  a  ridge  of  almost 
any  size,  will  have  more  or  less  so-called  suc- 
tion after  pressed  down  a  little  wliile.  And  any 
impression  ought  to  have  a  little  of  such,  though 
not  always  enough  to  hold  it  down  much. 

Nor  is  it  at  all  essential  tliat  a  lower  plate 
should  have  strong  suction.  Even  though  it 
should  stick  tightly  (as  most  of  them  will  for 
a  while),  the  tissues  will,  in  time,  be  absorbed 
and  tlie  ])late  lose  its  down'hold. 

(We  "11  liave  a  "Joker"  substitute  for  a  low- 
er suction  before  we  are  done  witli  it.) 


110  Greene  Brothers"  Clinical  Course 

But  in  any  test  I  want  at  least  to  hear  the 
impression  make  a  Uttle  "squashy"  noise  in 
working  it  up  and  down,  by  its  short  handle, 
as  proof  that  I  have  a  fit.  If  it  didn't  make 
any  noise,  I  'd  conclude  I  hadn't  the  best  fit 
that  could  be  made.  So  I  'd  set  about  for  an 
improvement. 

I  'd  not  take  another  impression,  however. 
If  I  were  to  make  one  hundred  sets  of  teeth, 
I  'd  take  but  one  impression  for  each  case 
And  I  'd  correct  each  one  till  I  got  mv  desired 
test. 

If  this  one  doesn't  test,  I  will  resort  to  Step 
Xo.  10. 

STEP  NO.  10  IN  LOWER  IMPRESSION. 
A  REVIEW  STEP. 

This,  if  needed,  would  be  a  review  step.  I 
would  first  trj^  the  conditions  of  Step  No.  9 
again.  Then,  still  failing,  I  'd  repeat  the  op- 
eration of  Xo.  7;  then  Xo.  6;  and  then  Xo.  5, 
in  turn  (in  their  backward  order),  till  I  found 
the  fault  somewhere. 

But  I  'd  look  especially  after  the  masseters 
and  lower^lip  strain;  not  forgetting  the  sub' 
lingual  tissues,  in  case  of  flat  gums.  But  in 
cases  of  much  alveolar  ridge  I  'd  rather  expect 
to  find  the  defect  in  poor  conforming  of  the 
lingual  edge  of  the  impression  to  this  ridge. 

But,  anyhow,  doctors,  I  'd  not  take  another 
impression:  and  then  another  and  another,  af- 
ter the  old  way.  I  'd  adjust  and  correct  up 
jjarts  of  the  same  one  in  detail  until  I  got  a 
iesf  that  would,  in  advance,  warrant  a  fit  of  my 
denture. 

Then  I  would  polish  its  edges,  if  not  its 
entire  surface,  over  a  spirit=flame;    and    go    on 


IX   Dental   Prosthesis.  Ill 

and  make  a  polished  model  that  would  mold,  or 
swage  me,  a  duplicate,  almost  finished,  denture. 

If  of  plaster,  this  model  is  made,  of  course, 
by  the  "full  saturation"  way  of  mixing  and 
pouring.  That  is,  the  correct  quantity  of  pure, 
teind  water  with  the  right  amount  of  good  plas- 
ter, mixed  thoroughly  but  quicldji  and  "poured," 
or  placed,  before  it  begins  to  harden. 

To  impress  an  important  point.  I  '11  repeat: 
Stirring  plaster  (or  any  other  crystallizing  sub- 
stance) after  it  has  commenced  to  set  much, 
breaks  the  forming  crystals  and  causes  rotten- 
ness of  the  ])roduct. 

A  PLASTER  LOWER  IMPRESSION. 

If  for  any  reason,  real,  imaginary,  habitual, 
or  otherwise,  I  sliould  want  a  plaster  impres- 
sion, I  'd  now  use  this  completed  modelings 
com])ound  one  as  a  tray  to  take  it  in.  I  'd 
pour  some  very  thin,  creamlike  plaster  (impres- 
sion plaster)  into  it,  sling  it  mostly  out,  and 
take  my  ])laster  impression  qiiickl//  with  light 
index'finger-pressure  and  wave=motion.  The 
wave^motion  is  to  cause  the  better  flowing  of 
the  ])laster. 

At  the  same  time  I  'd  have  the  ])atient  go  on 
and  repeat  all  the  lip-and^cheek  manoeuvres  she 
had  made  on  tlie  compound;  and  especially  bite 
down  a  little  on  my  fingers  to  provide  for  massi- 
ter  u]>lift  in  action.  That  is  to  say,  the  muscles 
would  ])us]i  the  plaster  out  and  ])revent  strain 
there. 

If  any  careless  excess  of  plaster  should  over- 
flow the  muscle=trimmed  edges  of  my  compound 
tray,  I  'd  rub  it  off  ])efore  making  my  model; 
and  use  tlie  modeling^comjXJiind  edges  as  my 
guide,  botli  in  ]K)uring,  and  trimming  my  model. 


112  Greene  Brothers'  Clinical  Course 

But,  doctors,  there  would  seldom  be  any- 
good  reason  for  the  plaster;  for  I  couldn't  im- 
prove such  an  impression,  even  technically,  un- 
less I  could  confine  it  (the  plaster)  and  employ 
the  conditions  of  the  "pass^word."  (Index  P.) 
Still,  as  it  requires  less  skill  to  equalize  with 
cream=like  plaster  than  with  tlie  spout=cup,  it  's 
the  best  way  for  a  novice — after  the  modeling'' 
compound  impression  has  been  otherwise  finished. 

The  making  of  a  model  here  would  be  the 
same  as  in  the  upper  case,  whether  I  used  all 
plaster,  or  my  non-changeable  approximates, 
and  faced  them  with  plaster. 

But  I  'd  make  it,  in  either  case,  immediately 
after  getting  a  satisfactory  test  of  my  impres- 
sion; or  else  keep  the  impression  in  cold  wa- 
ter till  I  could  make  it.  (Another  point  that  '11 
bear  repetition.) 

And  though  "this  is  neither  the  time  nor 
the  place"  to  give  the  valuable  secret,  I  can't 
forbear  to  tell  you  it  is  best  always  to  make 
a  plaster  model  as  thin  as  \^ou  well  can;  or 
at  least  trim  it  down  thin  after  it  is  made. 
Then  use  metal,  or  other  non=changeable  plates 
of  some  sort,  under  it,  when  necessary  to  raise 
it  up  in  the  flask,  in  packing. 

This,  doctors,  is  a  ]3ointer  worthy  of  a  gold* 
plated  safetyspin  in  it.  You  have  doubtless 
spoiled  many  a  case,  as  to  its  fit  and  occlusion, 
one  or  both,  by  putting  worthless,  mushj"  plas- 
ter under  your  plaster  model,  to  raise  it  in  your 
flask.  Have  you  ever  thought  of  it  ?  Doctors, 
think! 

This  all,  however,  more  properly  comes  up 
in  our  "third  degree,"  when  the  whole  model' 
smashing  matter  will  be  reviewed. 


IN  Dextal   Prosthesis.  113 

PARTIAL  LOWER  IMPRESSION. 

This  is,  to  some  extent,  a  repetition  of  the 
principles  involved  in  the  full  lower;  but  it 
takes  in  still  more. 

We  ^\dll  first  take  a  case  of,  say,  six  re- 
maining" anterior  teeth.  I  prefer  a  tray  with 
a  metal*closed  space,  or  place,  for  the  natural 
teeth  to  project  into;  but  open  ones  can  be 
closed  with  modeling  coinposition. 

See,  here  is  a  common,  ridiculous,  long' 
handled  one  that  we  '11  trim  up  and  down. 
We  '11  "transmogrify"  it,  as  some  call  my  bold 
surgery  on  the  old-fashioned  trays. 

We  '11  cut  off  the  long  handle  to,  say,  three* 
fom-ths  of  an  inch  in  length  and  hammer  it 
(the  shortened  handle)  down  thin  to  get  rid 
of  tipping  weight  and  inconvenient  bulk. 

We  '11  further  trim  down  its  sides  and  cut 
it  off  at  the  rear,  the  same  as  for  a  full  lower; 
and  especially  trim  it  off  clear  down  to  the 
handle  in  front.  This  last  in  order  to  take  the 
impression  of  only  the  ends  of  the  front  natural 
teeth  on  their  outer  surfaces. 

We  '11  want  to  change  this  impression  off= 
and^on;  so  we  want  room  to  look  under  and 
see  the  teeth  properly  re-enter  into  their  re- 
spective sockets  in  the  compound. 

(We  have  recently  perfected  a  set  of  trays, 
including  this  needed  one,  with  removable  han- 
dles; manufactured  by  the  Detroit  Dental  ]Man- 
ufacturing  Company,  Detroit,  ]Mich.) 

As  the  natural  teeth  here  act  as  guides,  to 
prevent  side=sli})])ing,  it  is  even  easier  to  take 
a  partial  impression  than  a  full  one — in  model- 
ing compound. 

^Vfter  the  tray  is  center^fitted  over  the  teeth 
and   alveolar   ridge,  as   in  the  full   case,   we   '11 


18] 


114  Grekxe  Brothers'  Clinical  Course 

take  a  roll  of  material  from  our  hot=waterspan 
and  shape  it  into  place  ("fashion"  it)  in  our 
tray,  as  we  did  before  in  the  full  case. 

We  '11  now  warm  it  over  our  hand=lamp 
flame,  as  in  the  full  case  before.  And  we  '11 
take  this  partial  impression  in  every  respect  as 
before  in  the  full  case,  through  to  the  finish 
of  it. 

All  that  was  shown  you  in  such  detail  as  to 
hardly  need  repeating  in  the  partial  case;  pro- 
vided the  teeth  are  so  shaped  and  stationed  as 
to  let  our  impression  in-and-out  of  the  mouth 
without  "drawing"  In  fact,  in  an  easy  case 
like  this,  it  requires  but  a  very  few  steps  in* 
and'out  to  do  all  I  have  told  you  and  shown  you. 

We  are  almost  certain  to  get  a  correct  im- 
pression of  the  alveolar  ridge  every  time.  So 
the  most  there  is  to  it  is  the  muscle=trimming 
for  relief  «  room,  especially  at  and  about  the 
heels;  and  the  conforming  on  the  lingual  side. 
H die j 'Without'} eak — and  the  story  is  told. 

"Yes,  hut"  emphasizes  one  of  you,  "what 
about  leaning  teeth  and  bell-shajDed  crowns, 
where  the  compound  must  draw,  or  it  '11  not 
come  out?" 

MODELING=COMPOUND    IMPRESSIONS    WITH    LEANING 
TEETH  AND  BELL=SHAPED   CROWNS. 

Well,  when  we  have  the  right  sort  of  mod- 
eling compound  and  know  how  to  use  it,  that 
once  vexing  problem  is  easily  solved.  Then  the 
old  bugaboo  vanishes.  Then  it  is  very  mucli 
easier  to  take  such  an  impression  in  compound 
than  in  plaster;  that  is,  plaster  in  the  old  way. 
The  best  old  way,  however,  is  new  to  a  ma- 
jority of  dentists. 

The  common  old  plaster  way  is  to  take  the 
impression,  teeth  and  all:  remove  the  tray  and 


IX  Dextal  Prosthesis.  115 

break  the  plaster  adhering  to  the  teeth  all  into 
uncertain  pieces,  in  the  mouth;  then  take  pieces 
out  and  stick  them  back  together — ^^and  make 
the  model. 

That  is  hard  on  the  patient;  besides,  all  the 
trimming  of  the  plate  afterward  is  by  guess* 
work. 

Even  if  using  all  plaster,  I  have  a  decided 
improvement  on  this  old  pull==andspush  way. 
I  make  the  plaster  break  easily  and  just  about 
where  I  want  it  to.  I  simply  place  layers  of 
thin  tin-foil  where  I  want  the  plaster  to  break. 
I  drop  the  little  foil  flakes  in  while  I  'm  filling 
the  tray.  The  foil  will  make  a  seam  in  the 
plaster  just  about  where  I  want  it  to  break 
apart.  Then  a  little  thin  cement,  such  as  we 
use  in  temporary  fillings,  will  unite  the  pieces  of 
our  purposely'broken  impression  to  perfection. 
The  Detroit  Dental  ]Mfg.  Co.  make  a  plaster^ 
cement  purposely  for  mending  broken  plaster. 

But  I  can  take  the  impression  of  these  lean- 
ing teeth  and  bell-shaped  crowns  just  as  well 
with  modeling  compound,  and  then  have  the 
benefit  of  my  accurate  muscle^trimming,  ^\'hich 
is  impossible  with  plaster  by  the  old  way.  Biitj 
7iozi\  hotv  to  do  this. 

CORING  OUT  FOR  UNDERCUT  IMPRESSIONS. 

I  first  carefully  ])ress  enough  compound 
around  the  teeth  to  build  them  out  to  cone* 
sliape,  instead  of  under*cuts.  Then  I  cool  it  after 
in  place;  varnisli  it  to  hold  tin*foil;  stick  on 
some  foil  and  dust  it  over  ^^•ith  powdered  soap- 
stone. 

I  then  treat  these  cored=out  teeth  just  as 
if  they  were  nafiiralh/  cone-shaped.  I  go  on 
and  take  my  impression  o\'er  the  cores  to  the  fin- 
ish, same  as  in  our  simple  case,  just  described. 


116  Greexe  Brothers'  Clinical  Course 

When  my  main  impression  is  m  u  s  c  1  e  = 
trimmed  and  conformed  on  lingual  side,  and 
out  of  the  mouth,  and  so  forth,  I  cool  my 
cores,  still  in  place  around  the  teeth,  VLell;  break 
them  away  from  their  x^laces;  take  them  out 
and  put  them  where  they  belong  in  the  main 
impression. 

Then  I  make  my  model,  preferably  using  my 
non=chargeable  approximate,  to  provide  against 
changes  in  plaster  and  in  my  dentures  from 
jjacking,  vulcanizing,  and  cooling. 

■'But,"  you  ask,  ''how  are  you  going  to  get 
your  })late  into  place,  when  made?"  Well, 
doctors,  tliat  's  your  job — not  mine. 

I  've  shown  you  how  to  take  your  impres- 
sion simply,  accurately,  and  with  a  minimum 
annoyance  to  your  patient.  If  you  have  a  case 
of  uiider=reach  wliere  the  plate  cant  he  entered 
as  a  farmer  enters  his  slide-bars  in  his  gate* 
way,  one  end  at  a  time,  you  11  have  to  cut 
away  some,  of  course.  But  be  careful  ichere 
you  cut.  and  cut  away  no  more  than  necessary. 
That  "s  all  you  can  do,  tliat  I  know  of.  Doc- 
tors just  set  your  brain  machinery  to  harmonize 
Avith  your  sul)  -  conscious  genius,  and  answer 
your  own  (juestion.  and  be  glad. 

But,  after  all.  doctors,  a  perfectly  fitting 
denture,  rightly  adjusted  to  the  muscles,  doesn't 
need  to  lit  close  against  the  teetli  at  all  points, 
if,  indeed,  at  any  point.  If  strained,  such  teeth 
soon  give  way  for  relief,  anyhow.  So  we  don't 
depend  on  a  fit  against  the  teeth  to  help  hold 
the  plate  very  long.  Such  help  is  beneficial 
only  in  lielping  liold  the  plate  in  ])lace  till  it 
adjusts,  or  imbeds,  itself. 

As  for  clasping  the  plate  to  the  natural 
teeth,  I  quit  that  thirty  years  ago  as  unneces- 
sarv,  when  not  reallv  harmful.     Still  I  concede 


IN  Dental  Prosthesis.  117 

there  are  partial  cases,  where  the  alveolar  ridge 
has  no  up'turn  at  the  rear,  where  the  telescope^ 
crown  scheme  is  useful;  that  is,  where  we  put 
on  a  permanent  crown  on  a  natural  tootli  and 
then  attach  a  telescope  crown,  or  band,  to  the 
plate  and  slip  this  latter  crown,  or  ring,  over 
the  first  one.  But  to  cut  down  any  sound  tooth 
to  crown  it  for  any  purpose  should  be  a  last 
resort. 

Also  a  little  extra  weight  is  frequently  a 
good  thing — ^^mainly  to  hel])  hold  it  down  to 
place  while  it  imbeds  itself  in  soft  tissues.  But 
that  will  come  up  and  be  explained  in  our  third 
lecture.    I  am  now  on  lower  impression. 

If  you  care  to  take  a  plaster  partial  (which 
is  seldom  sluj  advantage  where  the  modeling 
compound  is  taken  properly),  you  can  take  it 
on  the  compound  one,  by  means  similar  to  the 
"pass'word  method"  in  our  first  lecture.  (In- 
dex P.) 

But,  as  there  is  no  way  to  confine  much  of 
the  cream- h'ke  plaster,  the  main  point  in  the 
"pasS'Word"  scheme  is  wanting;  so  the  "equal- 
izing" (the  only  possible  purpose  of  the  plas- 
ter)  will  not  probably  be  much  improved. 

But,  should  you  equalize  with  "cream-like 
plaster  in  ready  flowing  condition,"  rub  the 
overflow,  if  any,  off  of  the  edges  before  making 
the  model.  The  compound  has  been  muscle* 
trimmed,  and  is  adjusted  to  the  movement  of 
the  tissues. 

OLD=TIME  IMPROVEMENT   IN   ALL.PLASTER  LOWER 
IMPRESSIONS. 

And  should  you,  foi-  ()ld=lial)it's  sake,  wish  to 
take  a  full  lower  al]=plaster  impression,  let  me 
suggest  hoxc  to  do  it.  But  you  needn't  bother 
about  telling  those  happy  old  "plaster  fiends," 


118  Greene  Brothers'  Clinical  Course 

who  are  sure  they  "already  know"  enough.  1 
know  their  self-satisfaction  tcell,  for  I  sat  be- 
side them  in  the  old  stage=coach  for  years,  re- 
fusing to  be  unsettled  myself. 

]Maybe  better  let  'em  enjoy  the  pleasure  of 
the  gambler's  chance  of  hope=and'doubt  that 
always  goes  ^\•ith  guess=trimming  and  guess* 
scraping  for  relief. 

But,  for  your  more  modern  selves,  use  our 
old-time  imjJi'ovement  on  the  old,  tissue=straining 
way.  That  is,  we  "transmogrify"  our  metal 
tray  and  fit  it  to  the  mouth,  as  I  have  shown 
you,  to  a  size  no  larger  than  the  plate  is  to 
be.  You,  of  course,  understand  the  tclifj  of  a 
shallow  tray. 

We  '11  now  punch  some  holes  through  it  to 
clinch  and  hold  the  plaster.  We  '11  trace  a 
table^spoonful  of  soft  plaster  along  on  the  limit- 
ed tray  and  take  impression  by  tremble'pressing 
down  very  lightly  with  our  two  index  fingers. 

We  '11  look  over  into  our  smooth  earthen 
bowl,  and,  when  the  remnant  of  plaster  there- 
in has  just  begun  to  set  a  very  little  we  '11  tell 
our  patient  to  close  her  mouth,  bite  on  our 
fingers  very  lightly,  swallow,  suck  her  lips,  and 
work  her  cheeks  mildly — and  do  it  all  quickly 
and  stop. 

When  she  has  done  as  told,  I  hold  down  the 
impression  steadily  (or,  better,  have  patient 
hold  it  down  with  index  fingers)  till  the  plaster 
is  hard  in  the  cup. 

When  I  take  it  out,  I  '11  find  the  plaster 
cracked  around  the  edges  of  my  tray,  and  lifted 
uj)  behind  the  back  ends  of  its  wings.  We  '11 
trim  off  to  the  crack,  and  Ave'll  have  the  most  com- 
plete all^plaster  impression  possible. 

The  moving  tissues  have  cracked  the  sur- 
plus  material  at  the  edge  of  my  narrow  tray 


IX   Dental   Prosthesis.  119 

and  told  me  about  where  to  trim  it  to  for 
relief. 

We  can  even  apprOiViniately  test  this  im- 
proved allsplaster  impression,  provided  we  have 
no  long,  heavy  handle  to  tray  to  tip  it  over. 
To  make  the  test,  we  '11  do  just  as  we  did  a 
while  ago  in  our  modeling-compound  impres- 
sion, in  Step  No.  9,  of  the  full  lower  case  (p.  112) . 

Of  course,  it  will  not  stay  down  as  our 
modelingscompound  impression  did,  because  of 
its  imperfect,  file=guess  trimming.  But  it  zdll 
tell  us  just  about  how  a  plate  from  it  would 
stay  down,  at  the  start,  anyhow.  Of  course, 
it  would  stay  down  better  after  worn  a  while 
for  adjustment. 

To  some  of  our  old  plaster  friends,  this  im- 
provement would  be  worth  only  98  cents  be- 
cause it  would  disturb  their  pleasures  in  trim- 
ming by  the  old  college^gag  instructions:  "Trim 
till  you  tJiink  you  've  spoiled  it,  and  then  more 
till  you  are  sure  you  've  spoiled  it — and  then 
some." 

And  worse  still,  doctors,  it  would  steal  from 
them  some  of  the  sweets  of  the  guess-gambling 
luicertainty  in  plate*work. 

Yea,  doctors,  yea,  even  this  iniprovement 
^^ould  rob  some  of  the  "best  men"  of  their 
names  at  the  head  of  journal  articles  advis- 
ing "Only  plaster  for  impressions";  because  it 
would  timely  lead  them  entirely  away  from 
plaster  at  all — in  lower  impressions,  at  least. 

Better  let  'em  go  on  with  tlieir  long,  deep, 
and  longshandled  trays,  and  their  five*])ound 
thumb=pressure  that  distorts  the  mouth  all  out 
of  shape,  so  they  can  trim  and  trim,  time  after 
time,  with  gambling*feature  ecstasy.  Then  in 
the  end,   to   dismiss   the   case   with  multi*assur- 


120  Greene  Brothers'  Clinical  Course 

ance  to  patients  that  "lower  plates  don't  stay 
down,  nohow." 

But  as  for  yoiu'selves,  doctors,  practice  these 
things,  first  a  little  in  your  oAvn  "oral  cavi- 
ties," then  in  the  mouths  of  your  forbearing 
mothers=in'law,  "sisters,  cousins,  and  aunts"; 
and  announce  to  nauseated  humanity  that  you 
don't  need  to  use  plaster  in  mouths  at  all. 

Or,  to  be  "ethical,"  get  your  patients  to 
tell  it  around  as  a  secret  that  you  no  longer 
need  a  half'gill  of  mushy  plaster  in  a  3x3  tray 
to  choke'gag  people,  by  forcing  it  dow^n  their 
throats,  like  cramming  geese  to  fatten  them. 

Doctors,  please  pardon  this  outburst  of  im- 
patience with  these  over-sized  trays;  over^bulk 
of  material;  and  over=strain  in  needlessly  dis- 
gusting patients,  in  taking  impression.  It  's 
worse  than  mal=practice;  for  mal^practice  may 
have  the  apology  of  selfish  motive. 


IN  Dental  Prosthesis. 


121 


Fig.  13. 


Fig.  14.  ,Fig.  15. 

Fig.  13. — Modeling-compound  impression  as  usually  taken  in 
common  deep  tray.  Plate  from  it  would  have  to  be  guess-trimmed 
to  fit  straining  tissues — difficult  if  even  possible. 

Fig.  14. — Same  tray  cut  down  and  fitted  to  the  mouth.  [Mod- 
eling-compound impression  (same  mouth)  just  as  taken  by  the 
3reene  muscle-trimming  method.    No  trimming  of  plate  after  made. 

Fig.  15. — "Correctable"  (approximate)  modeling-compound 
impression,  taken  from  model,  ready  for  re-taking  and  adjustment 
to  the  mouth.     (Student's  method.) 

[Cuts  represent  three-fourths  of  full-sized  impression.] 


122  Greexe   Brothers'  Clinical  Course 

TO  REFIT  A  VULVANITE  LOWER  PLATE,  TEMPORARILY. 

You  should  keep  on  hand  a  supply  of  thin 
M'afer  sheets  and  various  thicknesses  of  this 
"Perfection"  material.  To  prepare  it  ,  you 
press  it  out  on  a  smooth,  wet  surface,  prefer- 
ably of  glass  or  marble.  AVarm  it  in  a  com- 
mon tin  pan  and  firmly  slide^press  it  out  with 
a  smooth  bottle  or  tumbler,  also  wet.  But  it 
is  now  furnished  by  the  Detroit  Dental  ]Manu- 
facturing  Company,  of  Detroit,  ]Mich.,  ready 
for  use. 

A  2:)atient  comes  to  your  office,  maybe  when 
you  are  busy  at  your  chair,  and  insists  that  her 
teeth  be  ''tig-htened,  somehow."  You  say  to 
your  patient  in  the  chair:  "Keep  your  seat 
and  read  this  little  article  in  the  paper,  three 
or  four  minutes,  while  I  refit  the  old  lady's 
plate." 

Seat  the  complainant  in  your  impression^ 
chair.  (Maybe  blindfold  her,  too.  lest  she  may 
learn  too  much  about  refitting  plates  herself.) 
Wash  her  plate  clean  Avith  a  stiff  brush  and  dry 
it  thoroughly.  (This  may  be  the  biggest  sec- 
tion of  the  job.)  Heat  a  thin  wafer  sheet  and 
stick  it  on  till  it  perfectly  adheres  to  her  plate. 
It  must  actually  adliere,  and  not  mereh^  stick. 
And  it  must  cover  the  entire  surface  of  the 
plate,  too. 

Then  add  another  thickness  onto  the  first. 
You  can't  stick  a  single  thick  piece  tighth'' 
enough.  When  the  second  piece  adheres  to  the 
first  all  over,  dip  the  plate  into  hot  water  a 
few  seconds,  and  have  her  bite  down  into  it 
quickly.     That  is,  to  take  her  own  impression. 

It  may  require  a  second  heating  and  bite* 
doAAii,  M'hen  the  plate  is  refitted — probably  to 
fit  as  well  as  it  ever  did,  possiblj^  better. 


IX  Dextal   Prosthesis.  123 

"Call  again,  ^ladam,  if  it  loses  its  fit  in  a 
few  days  or  weeks.  I  '11  then  have  more  time 
and  will  refit  it  permanentl3\" 

This  is  a  temporary  refit,  the  like  of  which 
I  've  known  to  continue  for  several  months. 
But  don't  neglect  to  caution  lier  not  to  wash 
her  plate  in  hot  water. 

She  maybe  returns  in  a  few  days  or  weeks 
and  wants  the  plate  refitted  again.  This  maji 
require  only  re*dipping  and  biting  again  as  be- 
fore; but  you  may  have  to  dry  and  add  an- 
other wafer,  as  before.  Your  judgment  will 
guide  you  in  it. 

TO  REFIT  A  VULCANITE  LOWER  PLATE  PERMANENTLY. 

To  do  this,  you  file  the  rim  of  the  old  j^late, 
including  its  heels,  ofi'  down  to  where  there  is 
no  under-cut  left.  Place  a  wafer  of  compound 
in  it,  and  add  fully  enough  to  restore  the  miss- 
ing rim  and  heels.  The  material  for  restoring 
the  filed*off  rim  may  be  traced'on,  as  hereto- 
fore shown. 

Xow  dip  tlie  whole  thing  into  hot  water, 
for  an  instant  only,  and  have  her  take  her  own 
impression  by  biting  lightly  into  the  old  plate. 
As  tliis  is  to  be  a  permanent  refit,  better  soften 
and  bite  twice  to  make  sure  of  a  correct  im- 
pression. The  second  time  you  '11  re^heat  by 
liot  stream  from  your  s])outscup. 

Xow  you  have  yoiu'  impression  in  the  old 
plate.  Go  on  and  very-edge  the  outer  rim,  and 
then  the  inner  rim:  and  then  conform  the  lin- 
gual rim;  and  then  take  tlie  impression  of  the 
fnenum  A\itli  essential  quickness.  In  short,  do 
it  all  just  tlie  same  as  I  've  sliown  you  in  case 
of  a  regular  lower  impression,  only  she  takes 
lier  own  impression  by  biting  down. 


124  Greene  Brothers'  Clinical  Course 

In  case  you  need  to  lengthen  the  lower  teeth 
{i.  e.,  open  the  bite),  you  simply  use  a  thicker 
sheet  of  compound.  And,  while  it  is  warm, 
have  patient  bite  down,  slowly  and  lightly,  till 
the  teeth  show,  or  the  features  show,  just  as 
you  want  them  to. 

Of  course,  if  the  teeth  need  changing  in 
their  position,  that  must  be  done  first  of  all. 
(See  "Refitting  Upper  Plate"  in  first  lecture.) 

You  have  now  tested  your  fit  and  in  all  re- 
spects have  fashioned  your  denture  to  suit  you. 
Flask  your  case,  teeth'points  downward.  But 
(to  repeat)  don't  put  rotten  plaster  under  it  to 
raise  it  up  in  the  flask.  If  it  needs  raising,  use 
some  non  =  changeable  substance,  like  metal, 
crockery,  or  glass,  to  avoid  mashing,  which 
might  change  your  articulation.  Of  course  you  '11 
use  the  Greene  Occlusion  Retainer  over  the  ends 
of  the  teeth  before  investing. 

Trim  off  and  varnish  your  plaster  invest- 
ment, or  bedding,  as  usual. 

Fit  the  metal  edges  of  your  flask  together, 
so  there  will  be  no  ti23ping  nor  rocking.  This 
is  to  avoid  change  in  articulation,  or  occlusion. 

'Now  fill  your  "double"  flask;  the  impres- 
sion first,  and  carefully,  to  avoid  air=bubbles; 
seeing  there  's  no  water  in  the  impression,  too. 

If  you  use  a  Greene  non-changeable  model, 
insert  it  in  the  impression  according  to  direc- 
tion for  their  use,  before  filling  the  full  flask. 

When  the  plaster  in  the  flask  is  hard,  warm 
the  case  slightly  over  dry  heat,  and  open — ^^at 
the  heels,  of  course,  first. 

If  you  have  properly  soaped'stoned  or  pol- 
ished the  impression  and  it  was  dry  when  you 
poured  the  model,  the  latter  will  come  out  whole 
and  smooth.     But,  should  it  break,  just  mend  it 


IN  Dental  Prosthesis.  125 

with  any  tooth=filliiig  cement  and  go  ahead,  as 
soon  as  the  cement  is  hard. 

Never,  I  say  again  and  again,  vulcanize 
against  plaster.  But  cover  your  model  witli 
tiu'foil,  or  other  metal,  or  with  Uquid  silex, 
diluted  with  water,  about  half=and=half ;  then 
smooth  it  with  soapstone  powder,  well  rubbed  on. 

If  you  have  provided  small  vents  for  the 
escape  of  a  possible  little  bit  of  surplus  vid- 
canite,  your  model'holding  half  of  the  flask  (at 
your  right)   is  ready  for  use. 

Xow  turn  to  the  plate^holding  half  in  front 
of  you;  warm  it  slighth^  and  remove  from  the 
old  plate  everything  and  all  that  constituted 
the  impression.  Then  scrape  for  a  new,  clean 
exposure,  all  over  flic  plate's  surface.  Xote  the 
direction,  ''all  over." 

Pack  evenly;  flask  witli  little  strain;  vul- 
canize ])r()])erly;  cool  slowly  and  thoroughly; 
then  take  out  your  almost  finished  work. 

There  are  other  ways  of  refitting  plates,  but 
none  tliat  embrace  tlie  Greene  nmscle'trimming, 
valve^edge-fltting,  and  the  like.  They  all  have 
their  defects  and  their  objections. 

The  impression  =  paste  methods,  the  latest 
fads,  are  (]uick,  but  faulty  and  very  incom- 
l^lete  witlial.  Tliey  are  fauliif,  in  that  they 
don't  take  equalized  impressions,  even  as  far 
as  they  reach.  Tliey  are  incomplete  in  that 
they  don't  extend  the  ])late  at  any  point  and 
tlius  don't  refit,  where  lies  nine^tenths  of  the 
lacking.  Xor  in  lower  cases  do  tliey  even  en- 
able the  widening  of  the  bite  and  lengthening 
of  the  teeth,  so  often  needed  after  alveolar 
abs()r])tion. 

Their  only  advantage  is  a  little  saving  of 
time,  provided   Ave   wanted  to  cover  only  their 


126  Greene  Brothers'  Clinical  Course 

limited  ajjplication,  with  incomplete  results. 
Their  application  is  limited  to  only  kind  o'  re- 
fitting the  main  contact  surfaces  of  vulcanite 
plate.  Why  not  refit  it  all,  and,  if  necessary, 
extend  its  area  while  at  it? 

I  say  this  with  regret,  for  I  'd  slop  clear 
over  with  congratulations  at  the  feet  of  the  in- 
ventor of  any  vulcanizable  preparation  that  'd 
enable  the  taking  of  a  complete  test  impression 
in  an  old  plate.  But  so  far  that  has  not  been 
even  approximated — nor  even  attempted,  as 
far  as  I  know. 

But,  after  all,  why  refit  more  than  tempor- 
arily at  all?  It  takes  but  a  very  few  minutes 
more  time,  and  a  few  more  cents  expense,  to 
du23licate  anew  the  plate  wholly,  than  to  refit 
it  properly  and  permanently.  And  as  for  the 
fee,  you  can  always  get  a  few  more  dollars  for 
the  few  minutes  extra  time  and  the  few  cents 
extra  expense,  for  the  all'new  material  denture. 

After  you  have  your  contract  to  refit  the 
old  plate  and  have  begim  your  A\'ork  to  hold 
your  patient,  honestly  inform  her  that  re* vul- 
canizing always  deteriorates  and  weakens  old 
jDlates.  And  that  it  would  cost  her  but  a  little 
more  to  use  all=new  material,  ^^llich  you  can 
warrant  not  to  break.  Good  rubber  ])roperly 
vulcanized  against  metal  won  't  break. 

Indeed,  if  your  fee  is  at  all  fair  to  your- 
self, you  can  afford,  in  selfish  interest,  to  use 
all^new  material,  anyhow.  And  here  's  the  way 
to  do  it: 

RENEWAL  OF  RUBBER  LOWER  PLATES  FROM  OLD  ONES. 

We  proceed  in  all  steps  just  as  we  do  in 
permanent  refitting,  clear  up  to  the  time  we 
begin  to  clean  out  the  old  plate  for  packing 
in  the  vulcanite. 


IX   Dental   Prosthesis.  127 

Then  and  there,  instead  of  removing  the 
impression  material  and  scraping  out  a  new- 
surface  for  the  refit=packing,  we  heat  the  case 
hot,  over  a  dry  flame — a  gasoline  stove,  for  in- 
stance. AVhen  Jiot,  we  take  a  suitable  instru- 
ment and,  beginning  at  the  heel,  lift  it  all  out; 
the  old  plate,  teeth  and  all,  together. 

Some  of  the  plaster  investment  around  the 
teeth  will  flake  loose;  but  we  '11  quickly  ce- 
ment the  pieces  back  into  their  places,  and  for- 
get them.  Then  we  '11  oil  the  teeth  and  re- 
move them  from  the  old  plate,  as  in  the  upper 
case,  before  described.  (Index  R.)  Then  care- 
fidly  replace  tliem  back  home.  In  rare  cases, 
we  may  need  to  cement  the  teeth  l)ack  into 
their  places  in  their  imbedment,  to  hold  them 
while  packing  around  them. 

Now  we  '11  cover  the  model,  and  all  other 
plaster  exposed,  with  tin-foil  (Xo.  4).  thin  silex, 
or  collodion,  and  pack  and  vulcanize  just  the 
same  as  if  we  were  making  an  original,  new 
plate.  In  fact,  when  done,  we  have  made  an 
entire,  new  plate,  in  connection  with  the  old 
teeth.  And  we  've  done  it  in  far  less  time, 
and  with  far  less  work,  and  also  much  less  an- 
noyance to  the  ]3atient,  tlian  to  have  made  it 
over  by  the  usual  metliod. 

The  right  amount  of  rubber  can  be  ])rac- 
tically  ascertained  in  different  ways:  as  by  the 
usual  ways  of  weighing,  or  measuring  in  water. 
But  a  simpler  way  is  to  take  the  base-plate  (or 
im])ression  material  in  refit  and  renewal  cases) 
and  roll  it  out  into  a  slieet  the  thickness  of  the 
vulcanite  sheet  we  are  going  to  use.  Then  lay 
the  sliect  of  base-plate  (in  this  case,  modeling 
comijound)  down  onto  the  vidcanitc  sheet  and 
scribe  it,  and  cut  off  to  the  scratch. 


128  Greexe  Brothers'  Clinical  Course 

Then  cut  the  vulcanite  into  suitable  pieces 
and  add,  say,  4  per  cent  extra;  and  go  on  and 
jDack  into  place. 

But,  as  guess=work  is  especially  unreliable 
and  objectionable  in  lower  cases,  it  's  best  to 
use  the  cloth,  as  described  in  our  first  lecture. 
(Index  C.) 

Of  course  Me  11  not  tin^foil  the  model  until 
after  the  cloth  has  been  used  and  dispensed 
with.  But  during  the  use  of  the  cloth  (which 
shouki  still  retain  some  of  its  starch)  the  model 
should  be  treated  to  powdered  soapstone,  well 
rubbed  on,  to  prevent  adhesion  of  the  vulcanite 
to  it. 

The  tin=foil  on  the  plate  after  vulcanizing 
is  readily  removed  with  mercurial  paste.  (In- 
dex M.) 

Bear  in  mind  that  in  thus  renewing  plates 
you  can  correct  any  fault  that  existed  in  the  old 
dentures,  either  as  to  lit  or  occlusion,  or  both. 

Probably  you  will  prefer  to  take  the  teeth  off 
of  the  old  plate  and  replace  them  (reocclude 
them)  with  sticky  wax  before  taking  the  correct- 
ing impression.  In  that  case  tlie  teeth,  in  sep- 
arating the  flask,  will  remain  in  their  imbedment 
instead  of  coming  out  on  the  old  plate. 

In  removing  teeth  from  a  \Tilcanite  plate  I 
prefer  the  ])lan  of  first  oiling  them  and  heating 
them  one  at  a  time  with  a  mouth  blow=pipe. 

WEIGHT  IN  LOWER  DENTURES. 

You  have  asked  about  the  weight  of  lower 
plates,  weighted  rubber,  etc.  Well,  in  some 
special  cases,  limited  weiglit  is  a  mighty  good 
thing,  though  hobby=riding  and  over-doing  have 
brought  tlie  practice  into  less  tlian  former  use. 

If  I  were  taking  impressions  and  using  plas- 
ter models  and  making  plates  generally  by  the 


IN-   Dextal  Prosthesis.  129 

old  ways,  I  'd  still  do  as  I  used  to  do:  weight 
down  a  good  many  of  them. 

But  now,  by  the  new  method,  it  is  far  less 
frequently  needed;  the  weight  being  mostly  to 
hold  the  plate  down  till  the  floating  tissues  ad- 
just themselves  to  it.  Xo  use  to  try  to  weight 
against  straining  muscles. 

While  I  have  other  means  than  weight  to 
use  instead  thereof,  which  I  '11  give  you  later 
on,  I  11  now  proceed  to  show  you  how  I  weight 
down  a  rubber  plate  to  the  exact  amount,  and 
at  the  exact  place.  I  may  want  it. 

TO  SHOT=WEIGHT  AN  OLD  PLATE. 

To  do  this,  we  11  go  back  to  our  refitted  lower 
plate.  When  we  get  ready  to  pack,  we  '11  stop 
and  take  an  engine-bur  and  cut  out  all  but  a 
mere  shell  of  the  rear  half  of  each  wing  of  the 
plate  that  ue  are  refitting.  This  is  to  be  filled 
with  the  finest  "'mustard'Seed"  or  "dust"   shot. 

To  prevent  the  shot  from  running  out,  we  '11 
place  across  the  back  end  of  this  excavation  a 
piece  of  rubber,  preferably  weighted  rubber; 
then  pour  in  the  shot  till  nearly  full.  Over 
this  bird  -  shot  we  '11  place  another  piece  of 
weighted  rubber;  then  go  on  and  squeeze  to- 
gether, vulcanize  and  finish  as  usual. 

When  taken  out  of  the  flask,  we  '11  have  a 
refitted  and  weighted  plate,  all  finished  but  a 
little  final  polishing:  which  we  "II  quickly  do,' 
while  rejoicing  over  the  knowledge  of  our  new, 
simple,  practical  weighting  scheme. 

TO  SHOTWEIGHT  A  NEW  PLATE. 

Having  thus  sh(^t=vv'eighted  an  old  plate,  now 
let  \s  weight  a  neic  one,  similarly.  We're  ready 
to  pack  our  case.  We  "11  take  a  little  strip  of 
weighted  rubber  and  wrap   it  around  a  goose* 

[91 


130  Greexe   Brothers'  Clinical  Course 

quill,  or  some  other  small,  tapering  thing,  and 
knit  the  niblier  edges  together,  so  as  to  have 
a  weighted-rubber  tube,  when  we  slip  it  off. 

We  \\  pinch  the  smaller  end  and  have  a 
tube,  the  larger  end  open.  We  '11  fill  it  with 
the  smallest  of  bird^shot  and  pinch  the  other 
end.  This  gives  us  a  weighted  =  rubber  bag 
filled  with  shot :  which  comes  witliin  about  five 
per  cent  of  solid  lead  in  weight. 

In  packing  we  '11  first  use  the  best  of  vulcan- 
ite around  the  pins  of  the  teeth,  or  in  the  holes, 
if  pinless  teeth.  Then  we  "11  lay  a  sheet  of 
weighted^rubber  on  either  side;  and  then  place 
our  bag  of  shot  down  hctzcecu  the  two  side 
blankets:  then  go  on  and  com])lete  the  pack- 
ing with  weighted=rubber,  and  vulcanize  and 
finish  in  the  usual  way. 

But  use  only  the  best  of  rubber  in  front, 
where  the  plate  needs  all  strength  possible.  Xo 
weighted  rubber  there;  nor  any  more  ])ink  rub- 
ber than  actually  visible  in  wearing.  Xever 
face  with  pink  rubber  any  farther  down  from 
the  teeth  than  is  actually  seen;  that  is,  if  you 
wish  to  be  honest  with  the  wearer.  Xot  one  lower 
denture  in  a  dozen  indicates  ])ink  rubber  in  front. 
And  use  either  pink  rubber  or  weighted  rubber  in 
thick  lower  plntes  to  prevent  porosity. 

TO  STRENGTHEN  LOWER  VULCANITE  PLATE. 

Lower  plates,  cspccialUi  icJwii  vulcanized  in 
the  usual  hurried,  careless  icai/,  should  not  only 
contain  the  best  of  rubber,  })ut  should  be  addi- 
tionally strengthened  in  front  with  appropriate 
metal.  This  is  on  the  market  and  should  be 
used — unless  the  very  best  of  rubber  is  used 
and  vulcanized  at  the  lowest  temperature  and 
long  enough,  and  left  in  the  flask  cooling  long 


IX   Dextal   Prosthesis.  131 

enough    to    gi\e    it    the    cow^horn    texture    and 
.strength. 

MIXED    LOWER   PLATES. 

It  is  sometimes  an  advantage  to  make  a 
lower  phite  wliolly  or  partly  of  heavif  molded 
metal:  zchollif  when  a  maximum  of  both  weight 
and  strength  are  needed,  with  a  minimum  of 
))idk;  and  parti ii  when  a  maximum  of  weight 
ttvV//  a  mniimum  of  bulk:  and  partli/,  again, 
A\hen  a  maximum  of  weight  zcitli  a  minimum 
of  bulk  at  one  place  and  a  minimum  of  bulk 
with  a  maximum  of  weight  at  another  place. 

For  instance,  a  few  years  ago  I  had  a  case 
where  the  natural  teeth  were  all  missing  from 
and  including  the  central  incisor  back,  and  all 
the  ridge  gone,  on  one  side,  but  all  the  teeth 
remaining  and  healthy  on  the  other  side.  The 
teeth  were  missing  on  the  left  side. 

Here  I  needed  bulk  on  the  side  where  the 
teeth  were  to  be  put  in,  and  a  small  but  heavif 
flange  to  run  around  on  the  lingual  side  of  the 
natural  teeth  to  balance  the  artificial  teeth  on 
tlie  opposite  side. 

I  had  no  chance  to  crown  nor  to  clasp  witli- 
out  sacrificing  one  or  more  healthy  teeth,  whicli 
I  didn't  want  to  malj^racticingly  do. 

So  I  first  cast  a  heavy  metal  plate  to  go  all 
around  on  tlie  alveolar  lack=of=ridge  on  one  side 
and  to  fit  against  the  hngual  side  of  the  nat- 
ural teeth  on  tlie  other  side  of  the  mouth. 

This  heavy  plate,  small  in  l)ulk,  fitted  up 
fairly  close  to.  but  not  quite  touching,  the  nat- 
ural teeth:  and  also  around  behind  the  wisdom* 
tooth,  resting  tliere  on  top  of  the  gums.  I  used 
vulcanite  (for  bulk)  under  my  artificial  teeth  on 
the  heavy  cast  plate. 


132  Greene  Brothers'  Clinical  Course 

The  cast'inetal  flange  on  the  opjjosite  side 
balanced  the  artificial  teeth,  and  it  was  a  suc- 
cess; though  others,  and  I,  had  "signally"  failed 
by  other  methods  before. 

Yes,  weight,  under  some  circumstances,  is 
a  good  thing;  indeed,  sometimes  by  the  old 
method  of  guess=file=trimming,  essential  for  real 
success. 

But  fortunately,  I  've  invented  a  "Joker" 
that  will,  by  our  methods,  nearly  always  super- 
sede weight. 

I  am  pleased,  however,  to  acknowledge  a  new 
invention  by  "Dr.  Gilmore  of  Indianapolis,  Ind.," 
known  as  "Gilmore  Attachments"  for  holding 
plates  to  place  where  there  are  good  teeth  or 
sound  snags  to  hitch  to.  It  is  excellent.  (They 
are  on  the  market  bv  tlie  Detroit  Dental  Mfg. 
Co.) 

Dr.  Gilmore  has  taken  the  Greene  verbal 
course  and  of  course  takes  liis  impressions  and 
occlusions  by  the  Greene  Methods. 

SWAGING  LOWER  PLATES. 

I  have  no  improvements  to  offer  to  the  best 
modern  methods  of  swaging  lower  plates;  ex- 
cepting that  in  the  use  of  modeling*compound 
impressions  I  'd  use  the  Greene  a])proximate 
non-changeable  model,  faced  with  an  equal  mix- 
ture of  the  best  Portland  cement  and  plaster,, 
well  ground  together  in  a  mortar  before  the 
mixing. 

Pouring  very  low^fusible  melted  metal  into 
a  modeling*compound  impression  is  possible  if 
the  impression  is  very  cold  and  the  metal  at  its 
lowest  fusible  temperature,  but  it  requires  care 
that  some  dentists  won't  be  guiltj^  of.  The 
agents  who  sell  modern  swaging  machinery  are 
the  experts  to  teach  the  art;  and  it  is  to  their 


IX  Dextal  Prosthesis.  133 

especial  interest  that  their  patrons  make  a  suc- 
cess of  the  work. 

CAST  ALUMINUM  PLATES. 

Cast  aluminum  plates  are  becoming  quite  a 
fad.  Like  in  all  other  prosthetic  matters,  it 
takes  practice  to  make  perfect  in  tliis.  I  have 
seen  enough  of  it  to  know  it  can  be  done  per- 
fectly; and  yet  comparatively  few,  as  yet,  have 
the  art  perfectly  at  hand  (1910). 

Even  experts  seem  to  disagree  as  to  whether 
or  not  a  cast  aluminum  plate  is  as  impervious 
to  the  secretions  of  the  mouth  as  a  rolled  and 
swaged  one  is.  Again,  others  of  equal  experi- 
ence claim  the  metal  itself  is  not  fit  for  uni- 
versal use.  And  that  's  my  conclusion  from 
what  I  've  observed  of  it.  Anyhow,  it  's  gen- 
erally too  light  for  lower  ])lates,  where  weight  is 
needed. 

If  cast  plates  ever  become  common,  then 
the  Greene  method  of  taking  finished  test  im- 
pressions will  be  prized  the  more,  because  it 
eliminates  all  filing  of  plates  after  they  are 
made,  unless  the  mouth  clianges. 

It  will  then  be  the  more  appreciated,  also, 
])ecause  plates  will  be  cast  to  accommodate  the 
features,  as  well  as  to  fit  the  mouth. 

With,  oiu"  plumperstest,  the  aluminum  mold- 
er  will  not  have  to  wax  up  a  guesssplumper  and 
then,  maybe,  file  most  or  all  of  it  off  of  his 
plate  in  red*hot  stove-pipe  verbosity. 

REFITTING  LOWER  CAST  METAL  PLATES  WITH 
VULVANITE. 

Lower  cast  metal  plates  can  be  either  re- 
fitted, or  wholly  renewed,  with  vulcanite.  When 
refitted,  tlie  procediu-e  is  the  same  as  we  liave 
just  gone  through  in  refitting  rubber  plates,  only 


134  Greexe  Brothers'  Clinical  Course 

the  old  metal  plate  must  be  scarified  and  pre- 
pared to  hold  the  vulcanite  lining  mechanicalli). 
Of  course  you  are  all  familiar  with  that  matter. 

SUBSTITUTION  OF  WATT'S  METAL  PLATES  IN  PLACE  OF 
VULCANITE   ONES. 

To  replace  a  \Vatt's  metal  lower  plate  in- 
stead of  a  vulcanite  one,  we  take  a  modeling' 
compound  impression  in  the  old  vulcanite  plate, 
according  to  instruction  for  refitting;  and  test 
it  to  know  for  certain  the  plate,  when  done, 
will  both  fit  and  occlude  properly. 

But,  if  you  prefer  a  plaster  impression,  take 
it  bv  the  "pass^word  method,"  so  you  can  act- 
ually test  it.     (Index  P.) 

\Vhen  your  impression  stands  the  test  and 
the  teeth  occlude  as  they  should,  then  invest 
j'^our  case  just  as  we  did  in  the  vulcanite  refit 
case;  only  use  a  Watt's  metal  flask  and  some 
suitable  investment  material,  instead  of  plaster. 
An  equal  mixture  of  plaster  and  powdered  pum- 
ice-stone is  good  enough,  especially  if  ground 
together  dry  in  a  mortar  before  mixing. 

Open  the  flask  so  as  not  to  break  the  model, 
which,  of  course,  is  of  the  investment  material 
and  not  very  strong.  When  open,  heat  the 
plate-holding  half  of  the  flask  hot  and  remove 
the  whole  thing — teeth,  plate,  and  all.  Then 
remove  the  teeth  from  the  rubber  plate  and 
cement  them  back  into  their  places  in  the  in- 
vestment. 

Close  your  flask,  blow  in,  and  test  for  clear 
vents,  dry  thoroughly,  cover  flask' joint  with 
silex  and  investment  stuff,  heat  flask  hot,  tap 
and  pour  metal  in  slowly. 

This  is  a  very  simple  thing  to  do,  after  you 
know  how  to  take  a   test  impression   in   an  old 


IN   Dextal   Prosthesis,  135 

(lenturL'.  And,  when  it  's  done,  you  "ve  sub- 
stituted a  new  cast=metal  plate  instead  of  the 
okl  vulcanite  one,  in  less  tlian  two  hours  from 
start  to  completion. 

Of  course  you  understand  this  includes  both 
a  re=adjustment  of  the  teeth  and  correction  of 
(K'clusion,  if  needed. 

TO   REFIT   AND   RENEW   A   CAST  PLATE   WITH   THE 
SAME  MATERIAL. 

This  process  is  just  the  same  as  any  other 
refit  up  to  the  time  of  flasking.  You  now  under- 
stand that. 

Xow  use  any  flask  made  for  casting  lower 
{)lates  of  heavy  metal,  and  flask  as  usual  in 
that  sort  of  work;  using,  of  course,  some  pro]3er 
investment  material  in  flasking,  instead  of  plas- 
ter— something  that  won't  crack  and  change 
by  lieat.  The  pumice  *  stone  -  plaster  mixture 
will  do. 

Open  and  remove  everything  clean  that  con- 
stitutes your  impression;  close  the  flask,  after 
coating  the  investment  (not  the  teeth)  witli 
h(|ui(l  silex;  tlien  blow  in  to  clear  your  vents. 
Then  silex  the  crack  l)etween  the  two  halves 
of  tlie  flask  to  prevent  the  escape  of  the  melted 
plate^material. 

Then  dry  well  and  heat  it  hot  enough  to 
melt  the  old  j^late  inside;  and,  while  thus  hot. 
])our  in  the  molten  metal  needed  to  make  up 
for  the  space  occupied  by  the  impression. 

Cool  it  and  take  it  out,  and  you  '11  have 
both  a  refit  and  a  new  metal  ])late.  out  and  out. 


136  Greexe   Brothers'  Clinical  Course 


LECTURE  NUMBER  THREE. 


ARTICULATION,  OCCLUSION,  BITE, 


AND  ALL  THEY  INCLUDE,  FROM  A  PRACTICAL 
STANDPOINT. 

Well,  doctors,  in  our  "Third  Degree'  les- 
son we  're  "up  against"  some  of  the  most  tick- 
lish matters  that  come  within  the  whole  range 
of  our  practice. 

First:  the  bite;  and  then  all  that  follows 
till  we  finally  dismiss  our  patient.  In  the  word 
finaUii,  I  hope  you  fully  catch  my  meaning. 
It  sometimes  means  away  off,  and  always  an 
hour  of  rejoicing. 

In  dealing  with  the  subject  of  "articula- 
tion," as  the  word  is  broadly  used,  I  shall  try 
not  to  go  into  any  mystical  wording  nor  theoret- 
ical discussion.  I  '11  take  for  granted  j^ou  've 
already  had  satisfaction  and,  probably,  a  surfeit 
of  all  that — and  often  to  the  exclusion  of  really 
practical  information  on  the  theme. 

You  've  had  actual  measurements  of  dead 
men's  jaws,  and  approximate  and  "average" 
theoretical  measurements  of  living  men's  jaws. 

You  've  had  maxillary  gymnastics  and  con- 
tortive  movements  on  remote,  if  not  imaginary, 
"planes"  and  hypothetical  cinwes  offered,  and 
sometimes  given  you,  till  you  maybe  feel  some- 
what as  the  old  farmer,  JNIoses  Gouge,  recently 
did  at  a  toney  town  "kay*fay."  (This  story  is 
vouched  for  h\  a  reliable  dentist,  who  insists 
on  my  using  it  as  a  happy  illustration  in  this 
lecture. ) 


IX   Dextal   Prosthesis.  137 

Waiter  (politely)  :  "Beef  steak,  pork  steak, 
chicken  giblets,  Belgian  hare,  quail-on=toast, 
baked  fish,  fried  chicken,  codfish*balls,  turkey* 
breast,  mutton^leg,  ham,  mackerel,  or  comitry* 
made  sausage?" 

Plain  Old  Commoner  (impatiently)  :  "Ohj 
you  make  me  tired!  Jist  go  'n'  git  me  the  com- 
mon, home=niade  sassage  that  1  can  kind  o' 
chaw  with  this  gol'blasted,  jimble^tumble  set 
o'  teeth!  They  don't  strike  togetheh,  so  1 
can't  eat  nothin'  much,  neithah  hahd  nah  saft" 

A  new,  enthusisatic  disciple  of  "anatom- 
ical occlusion,"  across  the  table,  butted  in  and 
gave  the  old  Hay-seed  a  regulation  dissertation 
on  articulation  of  artificial  teeth,  in  "meter" 
terms,  on  "occlusal  planes,"  "condyle  paths," 
and  "face=bow"  measurements,  till  he  got  tired 
again: 

"Yomig  man,  young  man,  if  my  teeth  lacked 
o'  cummin'  togetheh  right  M-hen  I  chawed  by 
your  way  o'  fixing'  'em,  accordin'  as  they  do  by 
the  tutheh  tooth  dentist's  larnt  gibberish,  I 
guess  I  couldn't  hold  'em  in,  even  when  I 
steadied  'em  with  a  big  chaw  o'  saft  terbacker 
on  botli  sides.  If  I  could  only  jist  git  a  set 
that  'd  come  togetheh  rif^lit  even  one  way,  I  'd 
be  glad  to  hold  'em  that  way,  and  let  the  tuth- 
eh fellehs  have  thairn  to  move  in  them  uncom- 
mon ways,  which  you  tell  me  mine  had  ort  teh 
move  an'  come  togetheh  in. 

"In  fact,  strangeh,  to  be  honest;  while  I 
wouldn't  dis])ute  yoh  high  college  lahnin',  T 
can't  jist  see  lioxi:  yo'  're  gwoine  teh  make  a 
set  o'  teeth  that  'd  awlis  come  togetheh  right 
and  even  all  'round,  when  a  felleh  bit  in  dif- 
ferent ways.  I  know  that  even  my  old  ter- 
backeh'Wohn=off  ones  didn't  do  that. 


138  Greene   Brothers'  Clinical  Course 

"You  might  do  it  in  yoh'  'unknown  tongue,' 
hut,   as  the  felleh  says,  'I   'm  from   Missouray.' 

"1  reckon,  of  kose,  if  the  okl  Masteh  had 
tuken  sich  a  notion  in  Plis  head,  lie  could  o' 
made  all  teeth  hit  togetheh  all  'round,  no  mat- 
teh  what  direction  nor  tchat  we  l)it  on  'em.  But 
one  thing  is  shoh:  He  didn't  make  in'iuc,  noh  none 
of  my  five  wives',  noh  seventeen  chillern's  do  it. 

"Well,  1  may  say,  'cepflu'  in  one  case;  that 
o'  my  fo'th  wife,  Suz=an  ^Nloriah.  An'  she  it 
was  who  made  hern  that=a=way  lieh  own  self. 
She  was  allez  stickin'  her  cliin  out  an'  grittin' 
her  bulldog  teeth  at  me  an'  my  chillern  by  my 
tutlieh  women.  She  woh'  her  front  teeth  off 
so  loAv  an'  even  that  ,s7/^'  could  bite  on  'em  any 
ways,  I  guess. 

"But,  now,  I  wouldn't  want  my  neighbohs 
to  think  /  had  my  shop^made  teeth  patterned 
afteh  ^loriah's,  nohow-." 

Well,  doctors,  we'll  first  set  up  a  double 
set  of  teeth  that  will  come  together  exactly 
right  "one  way,"  the  most  natural  way.  Then 
we  '11  set  them  to  strike  like  Suz=an  ^loriah's, 
"any  ways";  at  least,  any  practiced  way. 

And  we  '11  do  it  without  any  circumlocution- 
ary  verbal  mystification,  or  "unknown  tongue," 
to  describe  it;  or  even  complicated,  ponderous 
articulating  machinery,  that  requires  an  anat- 
omical engineer  to  run  it.  We'll  try  to  make 
it  all  so  simple  that  even  a  wayfaring  (etc.) 
dentist  can  understand. 

^ly  piu'pose  is  to  show  you  how  to  take  a 
test  articulation  (so-called  "bite")  and  prove 
its  correctness  in  advance,  tlie  same  as  we  test- 
ed our  impressions;  and  how  to  set  up  teeth 
in  even  the  common,  old  plain  line  articulatoi', 
and  get  all  tlie  movements  the  jaw  makes  in 
pr(ictic(d  use — and  even  more,  too,  if  you  want 


IN   Dental   Prosthesis.  139 

them.  Yes,  and  as  for  that,  aceoinplish  the 
same  results,  even  without  anii  articulator  at 
all,  other  than  the  mouth  itself,  as  for  that. 

One  of  the  hest  plate^workers  I  have  ever 
kno\\ii,  working  hy  the  old  guess=work  methods, 
has  made  artificial  dentures  for  fiftyseight  years, 
and  has  never  had  an  articulator  in  his  office. 

And  though  1  have  used  articulators  my- 
self for  fifty-two  years,  I  will  here  say  that  if 
I  had  no  advance  test  methods  in  getting  the 
true  relations  of  tJie  jazcs  (the  "hite"),  hut  had 
to  guess*off  everything,  as  I  used  to  do,  and 
as  most  other  dentists  still  do,  I  would  note 
throw  my  artificial  articulators,  "anatomicals" 
and  all,  onto  the  junk^pile.  For,  without  this 
true  relation,  the  hest  of  them  are  not  only 
faulty,  hut  may  he  ahsolutely  misleading. 

But,  with  the  eertainty  of  the  true  relation 
of  the  jaws  when  at  rest,  and  a  close  approdiina- 
fiou  to  their  movement  in  action  (the  "average"), 
and  with  an  articulator  to  help  manifest  these 
relations,  we  get  a  very  close  approximation  to 
a  correct  articulation  and  occlusion. 

There  is  no  trouhle  in  getting  the  exact,  true 
i-elation  of  tlie  jaws  at  rest  in  any  individual 
case.  But  as  to  their  relation  when  in  motion 
we  must  he  content,  at  the  first,  to  get  even  a 
close  approximation. 

We  have  heen  given  the  true  measurements 
of  dead  men's  jaws  and  ingenious  face  '  how 
measurements  of  living  men's  jaws,  "occlusion 
planes,"  and  "condyle  ])aths,"  and  the  like,  eveJi 
unto  hypertechnics.  And  thanks,  honor,  and 
glory  to  the  men  who  have  given  them.  Their 
teaching  is  often  hel])ful,  at  least  instructive. 

But,  unfortunately,  when  most  needed,  the 
starting  points   can't  he  located  with   certainty 


140  Greexe  Brothers'  Clinical  Course 

(excepting  by  the  imagination  of  enthusiasts) 
and  the  measurement  is  only  approximate,  af- 
ter all.  Xot  all  jaws  move  alike,  nor  does  the 
same  jaw  move  always  on  both  sides  alike,  nor 
does  the  same  jaw  at  all  times  move  the  same. 

So  we  sometimes  have  to  work  to  greatly 
varj^ing  bone  anatomy,  of  impossible  actual 
measurement,  and  to  irregular  muscular  move- 
ments, that  just  can't  be  relied  on  at  all,  ex- 
cepting as  a  plausible  theory. 

But  nevertheless  we  can  deal  with  each  in- 
dividual case  on  its  own  merits;  and  get  prac- 
tical results,  no  matter  about  the  size  or  shape 
or  angle  of  the  jaw-bone.  As  a  whole,  shortly 
told,  we  '11  do  as  we  did  in  our  impression. 
We  '11  get  first  an  approximation  and  then  cor- 
rect up  to  exactness  in  these  matters  of  articu- 
lation and  occlusion. 

So  now,  as  to  the  not  only  varying,  but 
even  changing  muscle  movements  that  we  must 
deal  with. 

In  articulation  we  sometimes  can't  depend 
on  adjusting  our  tco/A"  to  the  movements  of  the 
muscles  that  operate  the  jaw.  We  rather  must 
depend  on  adjusting  the  movements  to  our  work 

I  am  aware  how  absurd  it  may  seem  to 
some,  at  first,  to  propose  to  adjust  the  jaw 
movement  to  a  set  of  teeth;  and  yet,  if  it  were 
not  possible  and  expedient,  the  most  grateful 
science  of  orthodontia  would  be  fatally  crippled. 

The  orthodontist  must  sometimes  adjust  the 
maxillary  connections  and  accommodate  their 
action  to  the  position  he  has  given  the  natural 
teeth.  He  couldn't  have  gotten  his  grateful 
results  without  having  trained  the  movements 
of  the  muscles  (that  moved  the  jaw)  to  his 
work;  that  is,  to  his  changed  position  of  the 
natural  teeth. 


IX  Dextal  Prosthesis.  141 

NOW  FOR  THE  "  BITE." 

The  too  common  idea  of  a  bite  is:  the  nat- 
ural, horizontal  relation  of  the  alveolar  ridges 
of  the  upper  and  lower  jaws.  It  is,  however, 
correct  as  far  as  it  goes;  but  it  doesn't  go 
far  enough.  To  this  limited  idea  should  be 
added:  tcken  they  are  at  proper  distance  apart, 
perpendicjilarhj. 

Even  the  horizontal  relation  of  the  jaws 
often  changes  as  the  distance  apart  varies. 

Then,  a  practical  definition  of  a  sO'Called 
"bite"  would  be:  The  natnral,  horizontal  re- 
lation of  the  jaii'S  ichen  at  their  proper  distance 
apart.  The  distance  apart  meaning  the  length 
of  the  teeth  to  be,  plus  the  combined  thickness 
of  the  bite^plates  used. 

But  strange  how  man\^  dentists,  including 
some  of  the  brightest  among  them,  fail  to  con- 
sider the  distance  apart  of  the  jaws  in  taking 
a  bite.  Indeed,  I  've  found  more  than  a  few 
who  contended  even  that  the  distance,  or  width 
of  the  bite,  makes  no  difference;  hence  they 
could  change  it  at  will  after  taken. 

For  example:  If  you  need  a  starter  for 
thinking  on  this  feature  of  our  theme,  just  open 
your  oicn  mouths  and  observe  how  much  faster 
the  s])ace  increases  between  your  front  teeth 
tlian  between  your  back  ones. 

AVhat  's  true  of  your  natural  teeth  would 
hold  just  the  same  with  your  gums,  without 
your  teeth ;  or  with  plates  of  artificial  teeth. 

Xo  correct  bite  (or  horizontal  relation  of  the 
jaws)  at  any  given  distance  apart  would  be  cor- 
rect at  any  other  distance  apart. 

Then  the  first  thing,  and  tJie  thing,  in  tak- 
ing a  bite  is  to  settle  on  the  distance  apart 
you    want    the    jaws;    or,    in    other   words,    the 


142  Greene  Brothers'  Clinical  Course 

combined  length  of  your  teeth,  inckiding  thick- 
ness of  their  phites.  And  now  this  must  be 
exact,  too. 

Xor  can  it  be  changed  after  settled*on  and 
in  the  articulator,  unless  your  articulator  pro- 
vides for  the  opening,  or  dosing,  at  the  heel  the 
same  as  in  front. 

Xor  is  any  change  of  this  sort  (widening  or 
narrowing  of  bite)  ever  necessary,  if  you  will 
ascertain  to  a  certainty,  before  you  take  your 
bite,  how  long  you  want  your  artificial  teeth, 
including  plate,  to  be.  That  is,  in  effect,  how 
nuich  you  want  your  teeth  to  shoic.  We  '11 
call  it  tlieir  show*length.  And  this  is  easily  de- 
termined and  settled  with  certainty,  as  you  will 
presently  be  shown. 

ABSURDITY  OF  A  COMMON,  MOTIONARY  BITE. 

In  all  dental  prosthesis,  and  indeed  in  all 
dentistry,  and  in  all  the  unphilosophical  ideas 
and  acceptations  therein,  there  is  no  greater 
uncertainty  than  that  of  a  conunon,  inotionary 
(pardon  the  doubtful  but  needed  new  word) 
bite;  no  matter  in  what  "way"  nor  how  you 
may  take  it. 

In  fact,  when  closely  scrutinized,  it  amounts 
to  practically  an  absu relit y,  even  though  you 
do  sometimes  get  the  correct  relation  of  the 
jaws  by  it.  In  certain  kinds  of  difficult  cases, 
to  be  mentioned  later  on,  success  would  have 
to  be  almost  an  accident. 

Absurd  ioY  this  reason:  You  ask  your  pa- 
tient to  give  you  her  "natural"  bite,  when  she 
really  has  no  regular  bite  to  give. 

She  used  to  have  a  regular,  or  habitual 
bite  when  she  had  her  natural  teeth.  The  teeth 
then  held  her  jaw  in  a  certain  2)osition  so  much 


IX   Dental   Prosthesis.  143 

of  the  time  that  it,  in  fact,  regulated  and  es- 
tahHshed  the  movement.  And  that  movement 
then  was  her  "natural"  hite. 

She  tJicti  liad  no  troul)le  at  all  in  opening 
and  closing  her  mouth  very  nearly  the  same 
way  every  time;  the  same  as  when  hahit  reg- 
ulates the  muscles  that  give  the  drilled  soldier 
the  same  "regulation  step"  every  time,  if  there  's 
nothing  to  interfere. 

You  and  I  who  have  teeth,  either  natural 
or  long=worn  artificial,  have  our  hahitual  ( "nat- 
ural") bites.  But  pull  our  teeth  out  and  let 
our  jaws  hang  loose  awhile,  like  a  bell=clapper, 
or  clockspendulum,  then  our  muscles  that  move 
our  jaws  relax  and  lose  their  habitual  action. 
Then  we  have  no  natural  bite  to  give.  We 
have  simply  lost  our  habitual  bite. 

.Vnd  fJicii  to  cram  a  mouth  full  of  unnatural 
filling  and  under  such  circumstances  to  expect 
a  natural,  same  bite  is  the  acme  of  presump- 
tion, if  not  an  a})surdity. 

So,  we  'd  just  l)etter  take  for  granted  that 
our  patient,  having  no  longer  a  certain  habitual 
action  of  her  jaw,  can't  control  her  movement: 
tlie  morcnu'tit,  mhid  you.  That  is,  she  can't 
bite  for  us  reliahlf/. 

TIRED   RELAXATION   THE   NATURAL   POSITION 
OF  THE  JAW. 

But,  though  slie  has  no  longer  an  estab- 
lislied,  habitual  movement  of  her  jaw,  she  al- 
ways has  a  natural  rest  position  of  it.  We  '11 
call  it  a  tired-rest  position. 

For  instance  (to  my  clinic=student  at  my 
left)  :  ^ladam,  let  us  illustrate  our  case.  Open 
your  mouth  and  stick  your  jaw  out  at  me  for 
a  little  while.     Don't  let  your  teeth  come  quite 


1-44  Greexe  Brothers'  Clinical  Course 

together;  but  hold  them  just  that  way  a  few 
moments. 

Xow,  how  long  could  you  hold  it  in  that 
strained  position,  with  nothing  to  rest  on^  "Not 
long,"  you  say.  Xo,  of  course  not;  but  what 
would  happen  when  you  couldn't  hold  it  out 
any  longer? 

"It  would  go  back,"  you  reply.  Back,  but 
where  to? 

"Back  to  its  natural  place,  of  course,"  you 
answer. 

That  'a  it!  When  your  jaw  is  tired,  it  goes 
back  to  its  natural-rest  position.  But  it  doesn't 
have  to  be  stuck  out  that  way  to  tire  it,  at  all. 
We  can  tire  it  in  a  simpler  way  than  that.  I 
have  used  that  way  to  impress  you  with  the 
principle. 

We  can  tire  your  jaw  quite  sufficiently  in 
a  minute  or  less  by  merely  holding  your  gums 
apart,  with  your  lips  Ji^hthi  touching.  We  '11 
apply  the  principle,  in  taking  a  bite,  now  soon. 

WHAT  DO  WE  EXPECT  FROM  A  BITE? 

There  are  four  important  points  that  we 
should  secm'e  in  a  bite. 

First:  The  length,  or  showing  (showslength) 
of  the  teeth. 

Second:  The  out^standing,  or  in=standing,  of 
them. 

Third:  The  come  together,  or  occlusion,  of 
them. 

Fourth,  but  not  least:  The  strain,  or  press- 
ure, with  which  tliey  come  in  contact. 

Though  the  fourth  point  is  unthought  of  by 
ninety-five  per  cent  of  dentists,  it  is  extremely 
important;  since  the  Avhole  matter  of  occlusion 
may  largely  depend   on  it.     We   will   deal  at- 


IX  Dextal  Prosthesis.  145 

tentively   with   point    four   in    its   place   a   little 
later  on. 

There  are  two  methods  of  taking  a  bite, 
with  variations  in  both.  One  is  known  gener- 
ally as 

THE  "BISCUIT,"  OR  "MUSH,"  OR  "SQUASH,"  BITE. 

It  consists  in  placing  a  roll,  or  chunk,  of  wax, 
or  other  material,  in  the  mouth  and  having  pa- 
tient simply  "bite"  on  it.  The  other  is  known 
as 

THE  RIM  BITE. 

Basesplates  are  made  of  various  materials 
to  approximately  lit  the  gums,  and  rims  of  wax, 
or  other  material,  placed  on  them;  then  bit'On 
and  marked,  and  fastened  together  on  their 
models,  in  the  articulator.  These  are  the  two 
methods,  given  without  detail;  and  it  is  sup- 
posed that  you  are  familiar  with  one  or  the 
other,  or  both  of  them.  My  only  use  for  them 
is  as  a  basis  for  illustration  and  improvement. 

By  tliis  biscuit  bite,  you  get  no  otie  of  the 
four  points  needed,  iWdCtJif;  and  seldom  very 
approximately,  unless  sometimes  when  it  is  pro- 
vided to  give  the  first  one  (length  of  teeth),  in 
a  way,  by  use  of  a  "bite=stick."" 

This  is  accomj)lished  by  placing  a  piece  of 
wood  in  the  "biscuit"  to  stop  the  lower  jaw 
at  the  ]u-o])er  distance  from  the  upper  one,  and 
so  give  the  length  of  the  teeth. 

But,  as  this  is  seldom  done,  it  is  safe  to  say 
that  generally  in  the  biscuit  bite  you  get  noth- 
ing you  want,  excepting  a  very  remote  approx- 
imation of  the  relation  of  tlie  jaws.  It  is  really 
about  all  guess-work. 


[10] 


146  Greene  Brothers'  Clinical  Course 

And  whatever  success  is  attained  to,  can  be 
attributed  to  your  experience  and  good  guess- 
ing, in  setting  up  the  teeth  and  trying  them  in 
the  mouth;  the  unrehabihty  of  which  will  be 
dealt  with  later  on. 

By  the  way,  before  we  close  this  demonstrat- 
tion,  we  '11  give  you  some  important  improve- 
ments on  the  old  "mush"  bite,  that  you  can 
give  your  friends  wlio  persist  in  its  use.  For 
yourselves,  you  '11  have  no  further  use  for  the 
method,  even  improved. 

This  rim  =  bite  method  ^vas  originally  in- 
tended to  give  the  first  three  of  the  aforemen- 
tioned points;  that  is,  length,  prominence,  and 
occlusion. 

But,  as  tlie  method  has  been  seldom  prop- 
erly taught  and  practiced;  and  as  faulty  ma- 
terials have  been  used;  and  as  dentists,  dis- 
couraged, have  adopted  and  rely  on  the  "try* 
insthe=mouth"  plan;  and  as  the  rim  bite  (as 
it  is  commonly  used)  has  to  be  followed  up  by 
cut=and=try  guess-work  to  get  even  what  is  at- 
tainable by  it,  I  '11  give  you. 

THE  GREENE  IMPROVED  AND  PERFECTED  RIM  BITE. 

This  gives  all  the  foil?'  requisite  points  with- 
out any  guess-work.  And  this  is  the  work  we 
are  now  up  to. 

BITE  FOR  A  FULL  UPPER=AND=LOWER  SET. 

We  have  our  models,  over  which  we  are  go- 
ing to  vulcanize,  or  swage,  our  plates.  If  we  take 
good  impressions  of  them  in  "Perfection"  Im- 
pression Compoimd  material,  our  impression- 
bitesplates  will  fit  to  the  gums  about  as  well 
as  the  finished  plates  made  from  them  will  fit 
later  on.    And  a  good=fitting  bite=plate,  one  that 


IN  Dental  Prosthesis.  147 

will  stay  to  place,  is  an  essential  in  the  bite.  Don't 
lose  thought  of  this. 

UPPER  MODEL  FIRST. 

We  '11  take  our  upper  model  first;  lay  it 
down  on  the  table,  face  upward,  soapstone  it 
well,  and  carefully  take  a  "Perfection"  mate- 
rial impression  from  it. 

This  impression,  taken  without  a  tray,  will 
liave  a  rim  of  ample  thickness  and  prominence, 
for  trimming  down  to  what  we  may  want.  But 
its  palatal  arch  Avill  be  pressed  down  thin — say, 
doAMi  to  an  eighth  of  an  inch  in  thickness — to 
avoid  bulk;  and  made  smooth.  It  will  then 
constitute  our  bite^plate,  in  the  rough. 

In  a  few  cases,  where  a  model  will  have  a 
projection,  you  will,  before  taking  an  impres- 
sion of  it,  have  to  core  out  the  "under'Cut" 
with  a  little  compound,  and  cover  this  with  thin 
foil,  so  as  to  get  it  off  the  impression  without 
damage  or  trouble. 

TRIM  FOR  FULLNESS  OF  UPPER  LIP  AND  TEETH. 

We  '11  now  put  it  into  our  patient's  mouth, 
after  a  little  explanation  to  her,  and  say:  "Now, 
JNIadam,  suck  that  up  tightly." 

To  begin  with,  it  purposely  makes  her  lip 
a  little  too  prominent.  But  ^^e  trim  off  until 
it  suits  us  as  to  fullness  of  expression — without 
regard  to  the  lower  jaw,  at  all.  In  fact,  we 
hold  our  hand  over  the  lower  lip,  during  the 
adjustment  of  the  upper  one.  to  avoid  being 
misguided  by  the  contrast. 

The  trimming  is  done  similarly  to  that  in 
side*trimming  an  impression:  first  warming  the 
outer  surface  to  a  very  slight  depth  over  a 
hand'lamp,  and  then  using  a  sharp  pocket=knife. 


148  Greene  Brothers'  Clinical  Course 

It  now  reprensents  the  fullness  of  our  coming 
denture  all  around. 

AVhile  I  'ni  not  here  to  teach  you  physiog- 
nomatic  taste,  at  all,  I  will  suggest  that  you 
don  't  give  your  patients  a  cat^fishy  appearance 
by  too  square  a  front  and  too  prominent  bicus- 
pids— ^^a  very  common,  distortive  habit  among 
dentists.  And  always  beware  of  tucking  the 
front  teeth  inxcard,  or  the  bicuspids  oiitncard^ 
too  much;  especially  for  a  woman — unless  you 
want  to  make  her  husl)and,  or  beaux,  look  at 
some  other  face.  All  dentists  guilty  of  this 
unpardonable  sin  against  featural  symmetry 
should  be  de*licensed.  And  oh,  what  a  lot  of 
vacant  chairs  there  would  be! 

TRIM  BITE=PLATE  FOR  LENGTH  OF  UPPER  TEETH. 

Next  we  '11  get  tlie  "lip=line"  for  the  show* 
length  of  our  artificial  teeth.  This  you  can  get 
in  your  usual  way,  whatever  that  is;  only  be 
sure  you  get  it.  I  prefer  to  use  the  laugh* 
stunt,  as  a  rule. 

We  look  her  in  the  eyes  blandly  and  say: 
"]Madam.  please  smile  or  lan^h  a  little  at  me, 
will  youT'  She  laughs,  always  promptly,  when 
told  to.  So  we  trim  till  we  get  the  rim  to  ve\i- 
resent  the  exact  length  we  want  the  teeth  to 
show;  that  is,  their  show=length  as  far  back  as 
they  will  show. 

Then,  not  as  a  matter  of  taste,  but  as  one 
of  mechanical  philosophy,  trim  off  the  rest  of 
the  rim  behind  so  as  curve  gradually  upward; 
and  make  your  last  molar  as  short  as  possible 
(the  exception  would  be  M'here  you  want  to 
prevent  the  cheek  from  falling  inward)  ;  first, 
that  your  denture  may  have  the  "compensat- 
ing curA^e"  (incidentally)  ;  but  for  another  more 


IN  Dental  Prosthesis.  149 

potent  reason  than  the  one  usually  given,  to  be 
explained  later  on. 

So  now  we  have  our  upper  rimsbitesplate  to 
represent  our  teeth  when  set  up.  It  will  be 
our  guide,  too,  in  setting  them  up. 

Xext  we  '11  do  the  same  thing  in  our  lower 
case.  As  in  the  upper,  we  '11  get,  again,  our 
rim*plate  impression  from  our  lower  model  (or 
from  the  mouth,  as  for  that) .  But  we  must 
see  that  it  will  stay  dozen — ^^somewhat,  at  least — 
to  its  place  in  the  mouth.  This  is  important 
and  almost  essential  in  getting  an  ante^test 
bite.  If  tlie  mouth  has  an  alveolar  ridge,  it 
will  suck  down;  but,  if  not,  we  must  other- 
wise provide  for  its  down^stay. 

In  this  flat,  flabby  case,  we  must  have  a 
substitute  for  suction  in  our  lower  bitc'plate. 

HEAVY  LOWER  BITE=PLATES. 

Here  icatch  mij  most  valuable  little  invention 
ever  made  in  bite-taking-.  We  '11  take  the  im- 
pression of  our  lower  model  with  heavily  tceight- 
cd  molding  compound — that  is,  compound  with 
fine  bird=shot  well  kneaded  into  and  through 
it;  and  even  with  small  bars  and  rolls  of  lead 
also  worked  into  the  rim,  if  necessary,  to  hold 
it  down  to  place. 

TRIM  LOWER  BITE^RIM  FOR  LENGTH  OF  LOWER  TEETH. 

AVe  're  now  ready  for  trimming  and  fitting 
our  lower  bite-plate  to  the  up])er  one.  But 
we  '11  reverse  the  order  and  get  tlie  sliow=lengi:h 
for  the  teeth  first.  Don't  forget  that  in  the  up- 
per case  we  first  got  the  fullness  and  then  the 
show=length;  but  in  the  lower  case  it  is  exactly 
reversed. 

And  now,  doctors,  here  is  the  tvay  we  get 
the   lower   bite^rim   to   the    showslength   of   the 


150  Greene  Brothers'  Clinical  Course 

lower  teeth;  and  also  get  it  to  fit  to  the  upper 
rim.  For  they  must  fit  to  eacli  other  perfectly; 
their  edges  occlusively  and  outer  sides  evenly, 
laterally. 

With  the  upjDer  bite-plate  left  out,  we  place 
the  lower  one  in  the  mouth  and  mark  the  lip* 
line,  and  trim  to  it  in  front — 'say,  to  about  the 
combined  width^space  of  the  incisors.  In  scru- 
tinizing for  the  length  of  the  teeth,  look  at  this 
trimmed  place  only,  for  it  is  the  stop-guide  to 
the  rest  of  the  trimming,  to  be  made  elsewhere. 

When  this  guide^point  is  down  to  the  show- 
length  that  we  want  the  teeth  to  be,  we  soapstone 
or  tin- foil  this  trimmed  spot.  Then  insert  the 
upper  plate,  with  its  full  occluding  edge  like- 
wise soaped,  or  foiled,  and  cool.  Then  warm 
the  occluding  edge,  only,  of  the  lower  plate,  and 
have  patient  to  bite  down  quickly.  (This  isn't 
taking  the  bite,  excepting  the  press^strain  feature 
of  it.) 

The  trimmed  guide' point  is  cool  and  hard 
and  inmmned  from  sticking,  while  the  rest  of 
the  rim  is  soft  on  top,  so  it  will  mash  down  in 
forced  contact  with  the  hard  upper  rim.  In 
an  instant  she  has  mash  '  trinmied  her  lower 
bite^plate  to  exactly  fit  her  upper  one. 

Xow  when  we  trim  off  the  mashed^down 
surplus,  our  whole  lower  bite-plate  rim  repre- 
sents the  coming  lower  denture  as  to  its  show* 
length,  or,  rather,  height;  but  only  as  to  that. 
It  "compensatingscurves"'  upward  at  the  heels, 
too.    Well,  provided  we  M'ant  such  a  curve. 

THE  OUTSTANDING  OF  THE  LOWER  TEETH 

is  our  next  point  to  make. 

We  must  now  trim  the  outer  side  of  tliis 
lower  rim  off  all  around  even  with  the  upper 
one.     And  the  two  rims  must  be  even  Avith  each 


IX  Dextal   Prosthesis.  151 

other  icJicn  thcij  arc  in  their  exactly  true  natural 
relation  to  each  other.  That  is  to  say,  when  we 
have  the  correct  so==called  ''bite." 

When  we  determined  the  show=length  of  our 
teeth,  at  the  laugh'line,  or  elsewhere,  we  set- 
tled, by  critical  observation,  the  perpendicular 
relation  of  the  two  jaws;  now  we  must  settle 
their  horizontal  relationship.  This  can  be  done 
with  certainty,  only  when  the  lower  jaw  is  at 
tired  relaxation,  which  is  normal  rest. 

And,  doctors,  whether  deserving  or  not,  I 
Avill  here  venture  to  throAv  a  little  boquet  at 
my  own  old  feet.  Whether  the  discovery  is  orig- 
inal or  not,  I  am  sure  I  have  never  known  it 
mentioned,  in  all  the  forty  years  of  my  prac- 
tice and  association  with  dentists,  before  I  be- 
gan to  teach  it  in  my  private  Course  a  few 
years  ago. 

I  mean  the  taking  of  an  immotionary.  still 
bite;  or  no'hite,  as  I  will  now  call  it  to  the  end 
of  these  demonstrative  talks. 

But  even  though  the  idea  were  not  original, 
to  be  the  unquestioned  introducer  of  it  ])racti- 
cally  to  the  ])rofession  is  sufficient  honor. 


THE    TIRED=REST  TEST=BITE,  OR  "NO=BlTE." 

We  will  now  take  it,  then  trim  the  lotver 
})latesrim  off  to   evenly  match   the   upper  one. 

I  could  describe  the  ])rocess  more  briefly, 
but  less  impressively:  so  I'll  use  our  dummy 
l)atient  in  the  demonstration: 

"JNIadam,  you  now  have  the  two  ])lates  in 
your  mouth.  They  will  stay  to  their  ])laces.  If 
necessary  we  '11  stick  them  onto  the  gums  Avith 
paste  or  gum-tragacanth.  Look  me  in  the  face, 
listen  to  what  I  say,  get  my  idea  clearly,  and  do 
promptly  what  I  tell  you. 


(  /.//(. 


152  Greene  Brothers'  Clinical  Course 

"Close  your  mouth  till  your  lips  come  to- 
gether lightly;  but  let  the  plates  remain  just 
a  little  bit  apart,  but  so  thcij  'II  almost  touch." 

The  plates  ai;e  within  about  an  eighth  of 
an  inch  of  each  other,  and  too  near  to  admit 
of  uninicndcd  lateral  motion  in  closing  this  last 
minimum  space  under  the  directions. 

"There,  there,  you  have  it  right!  Watch, 
listen,  hold  just  that  way  till  I  slowly  count 
ten.  Then  bite  down  somewhat  firmly,  and 
hold  down,  no  matter  what  I  may  do  with 
your  lips.  Watch:  One,  two,  three,  four,  five, 
six,  seven,  eight,  nine,  ten — snap!  Hold  firmly." 

The  upper  rim  sits  down  on  the  lower  one 
at  tired  '  rest  position — provided  neither  plate 
moved.  And  here  you  see  the  utmost  import- 
ance and  necessity  of  well  '  fitting,  bite=plates. 
If  one  or  the  other,  or  both,  had  slipped,  ever 
so  little,  the  result  would  have  been  equivalent 
to  that  of  a  really  wrong  bite,  to  that  extent,  by 
side  movement  of  the  jaw  itself.  And  how  many 
bad  bites  of  this  sort  have  we  all  had  from  bad= 
fitting  and  sliding  bite*plates?  How  many  hun- 
dred have  you  had  ? 

Are  you  all  impressed?  If  so,  we  will  re- 
turn to  our  patient. 

"Hold  still,  Madam,  while  I  mark  the  lower 
IDlate." 

I  here  take  a  small  instrument  with  a  right- 
angle  turn  near  its  point  and  scratch  all  around 
on  top  of  the  extending  lower  rim,  against  the 
trimmed  upper  one.  That  is  to  say,  my  upper 
rim  guides  my  marker.  Then,  to  rest  my  pa- 
tient, I  take  both  plates  out  and  trim  the  lower 
one  off  to  the  scribe  carefully.  This  brings 
them  both  even;  and  even,  too,  xichen  the  jaws 
are  in   their  natural  relation — provided    I    can 


IX  Dental  Prosthesis.  153 

"show"  it  (and  I  ^^roudly  hail  from  the  "Show= 
me"  State) . 

Well,  I  have  now  attained  the  third  one  of 
my  four  essential  points  in  a  bite:      (1)    show* 
length  of  the  teeth;    (2)  the  come*together ;  and 
(3)    tlie  Up  and  face  features.     The  teeth  will   / 
relate  just  as  these  bite=rims  do.  / 

RE=INSPECT  NO=BITE  FOR  FEATURE  TEST. 

But,  to  make  sure  the  face  features  will  suit 
?ne,  and  thus  help  me  to  "suggest"  my  patient, 
I  '11  replace  the  whole  thing  in  the  mouth  and 
re^inspect. 

After  all  this,  however,  you  '11  not  need  to 
make,  on  an  average,  one  change  in  twenty- 
five.  But  should  you  see  fit  to  do  so,  all  that 
you  need  to  do  is  to  re-trim  your  rims  in  the 
same  way  you  did  in  the  first  place,  but  more 
carefully. 

You  can  place  your  bite=plates  on  their  mod- 
els, warm  the  rims,  and  push  them  outward  or 


Fig.   16. 

Fig.  16. — Greene  Tired-Re-.t  Test-Bite  (no-l)ite),  with  molding- 
compound  im])res.sion.s,  as  bite-plates — (in  this  case  handleless 
trays).     The  models  are  made  wlien  case  is  articulated. 


154  Greene   Brothers'  Clinical  Course 

inward.  You  can  trace  compound  (at  least,  this 
"Perfection"  brand)  on,  or  add  it  in  strips,  for 
more  extension;  or  trim  it  oif  for  reduction. 

FOURTH  POINT,  OR  PRESSURE  FEATURE,  IN  A  BITE. 

Xext  and  last  comes  the  fourth  point  of 
essentiahty  in  a  bite.  This  is  the  pressure,  or 
strain,  with  which  it  must  be  taken.  (And 
here  I  '11  take  the  risk  of  justification  in  another 
bouquet  at  my  own  feet.) 

In  traveling  seventy-five  thousand  miles,  in 
fourteen  years,  among  dentists,  I  have  found  less 
than  a  score  who  had  ever  thought  (out  loud,  at 
least)  of  the  importance  of  the  strain  with  which 
a  bite  is  taken;  or  even  of  a  set  of  teeth  set 
up  together.  And  only  one  of  these  had  at- 
tempted to  regulate  the  matter  in  his  work. 

I  fraternally  wish  I  could  recall  his  name; 
he  was  in  my  first  class  in  Washington,  D.  C, 
in  January,  190?  He  had  invented  an  inge- 
nius  little  instrument  to  measure  and  regulate 
dentalsplate  pressure;  only  he  hadn't  had  time 
to  perfect  his  appliance  to  his  own  satisfaction. 
His  purpose,  of  course,  was  to  apply  it  in  a  bite. 

A  SIMPLE,  PRACTICAL  PRESSOMETER. 

We  have  been  over  and  over  the  importance 
of  taking  impressions  at  about  the  stress  a  plate 
is  to  be  Morn — as  a  rule  with  few  exceptions. 
And  this  stress  would  be  at  about  strong  suction 
strain. 

Well,  it  's  just  about  as  important  that  a 
bite  should  be  so  taken,  too.  Otherwise,  our 
occlusion  wouldn't  be  as  expected,  and  we  'd 
have  more  or  less  after=grinding  to  do.  or  else 
waiting  to  do  till  the  tissues  absorbed  and  ad- 
justed themselves  to  the  plates.      Many  a  bad 


IN   Dental   Prosthesis.  155 

occlusion  is  the  direct  result  of  improper  press- 
ure in  bitc'taking. 

It  is  astonishing  how  many  of  us,  includ- 
ing scores  of  our  deep  "anatomical"  thinkers, 
have  so  long  danced  blindly  all  around  this 
now  plainly  visible  goddess  in  the  popular  Oc- 
clusion Show. 

But  we  have  all  heard  of  the  j^oor,  tired 
prospector  who  sat  down  on  a  boulder  of  gold, 
at  Cripple  Creek,  Colo.,  to  unwittingly  rest  on 
a  fortune,  after  he  'd  worn  himself  out  at  dig- 
ging and  searching  for  it  with  a  microscope,  in 
doubt,  away  do^^n  in  the  unknown  depths  of 
the  mountain. 

If  I  hadn't  such  well'grounded  prejudice 
against  commonly  sl&ndered  names,  I  'd  call 
my  instrument  "Eureka."  But  I  '11  wait  til] 
some  other  fellow  "invents"  the  same  thing  and 
let  hijii  so  name  it.    I  '11  christen  it:  Pressometer. 

To  describe  it  and  show  its  workings,  we  '11 
go  back  to  our  finished  no^bite.  It  looks  like 
it  is  finished,  for  the  plates  seem  to  come  to- 
gether all  around  alike.  In  fact,  in  a  way  they 
do  so.  But  we  don't  know  yet  how  much  more 
strain  ■ —  excessive  strain  —  is  being  made  some 
place,  or  ])laces,  than  at  others  to  make  them 
do  so. 

If  it  takes  too  much  strain,  the  teeth  wouldn't 
come  togetlier  perfectly  at  the  natural  strain  at 
which  they  will  be  worn.  And  of  course  other 
difficulties  come  "in  flocks  and  droves"  in  con- 
sequence of  improper  occlusion. 

HOW  TO  USE  THE  GREENE  PRESSOMETER  IN  A 
STRAIN  TEST. 

As  a  test  of  stress,  we  '11  use  these  two  nar- 
row, thin  strips  of  celluloid,  or  its  equivalent, 
about    half    an   inch    wide,    one*thirtieth    of    an 


156  Greene  Brothers'  Clinical  Course 

inch  thick,  and  four  inches  long.  They  are  as 
smooth  and  shck  as  a  glass  mirror.  They  are 
beveled  at  one  end,  so  I  can  lay  one  on  each 
side  of  my  lower  bit*rim  (in  the  mouth)  and 
have  them  come  jointly  together  in  front,  form- 
ing a  letter  V. 

They  are  also  rounded  off  on  the  outer  side 
at  the  heels,  so  as  not  to  be  caught  by  the 
cheek.  And,  when  laid  to  place  for  use  on  the 
lower  bite*rim,  they  also  project  out  in  front 
beyond  the  bite*rims,  so  I  can  handle  them 
with  thumb  and  finger.  The  two  together  con- 
stitute the  full  pressometcr. 

In  a  simple  case  like  this,  I  place  the  two 
halves,  one  on  each  side,  on  my  lower  bite- 
rim,  with  the  letter  V  pointing  toward  me. 

"Now,  Madam,  bite  down  on  these  strips." 

She  bites,  and  they  both  are  held  fast;  but 
this  proves  nothing;  for  I  don't  know  how  un- 
duly hard  she  is  biting  down,  nor  how  much 
some  parts  of  her  gums  are  giving  way  more 
than  other  parts,  to  make  them  thus  tightly 
hold. 

Then  I  say:  "Hold,  ^Madam,  hold!  Bite 
lightly/' 

She  bites  lightly,  when  one  of  my  test  pieces 
holds  tightly,  while  the  other  slips  loosely  be- 
tween the  bitesplates.  This  shows  there  was 
more  strain  on  the  tight  side  than  on  the  other 
one,  for  the  slips  are  of  the  same  thickness. 

I  now  take  the  lower  plate  out  and  file  it 
off  (it  is  here  modeling  compomid)  with  a  coarse 
vulcanite  file,  and  try  it  back.  Now  when  she 
bites  lightly,  they  both  hold  alike  and  slij)  alike, 
loosely,  showing  the  pressure  is  the  same;  j)i'e- 
cisely  the  same.  Then  teeth,  set  up  by  these 
equalized  bite*rims,  will  be  of  a  likeness  in 
pressure. 


IN  Dental  Prosthesis.  157 

If  I  hadn't  filed  off  the  hite=rim,  but  had 
gone  on  and  set  up  the  teeth  by  it,  I  would 
have  had  to  grind  ihcm  off  equivalently. 

UNEQUAL  PRESSURE  SOMETIMES  NEEDED  IN  A  BITE. 

But,  now,  I  wouldn't  have  you  understand 
me  that  stress  should  alrccu/s  be  the  same  all 
over  tlie  mouth.  That  is  the  first  conclusion 
new  thinkers  are  apt  to  jump  to.  But  in  many 
instances  the  strain  on  the  tissues  should  l)e 
unequal  at  different  places. 

For  instance,  we  have  a  mouth  where  the 
gums  are  soft  and  yielding  on  one  side,  and 
hard  and  unyielding  on  the  other  side.  In  the 
absorbing  adjustment  which  always  takes  place, 
more  or  less,  under  artificial  dentures,  especially 
lower  ones,  after  worn,  the  softer  side  will  change 
more  than  the  harder;  and  then  finally  the 
teeth  would  strike  together  first  on  the  harder 
side. 

In  this  case,  the  test=slip,  in  testing  the  bite, 
should  hold  the  tighter  on  the  soft  side,  where 
the  most  absorption  is  to  take  place.  We  have 
pairs  of  these  test^slips  of  unequal  thickness 
for  sucli  cases. 

Similarly,  if  we  had  a  case  where  the  mouth 
was  soft  at  the  rear  and  hard  in  front,  as  is 
often  the  case,  then  our  slides  should  hold  tight- 
er back  tliere  than  on  the  alveolar  ridge,  in 
front;  and  vice  versa. 

So,  you  see,  the  principle  holds  good  both 
ways.  So  the  simple  i)ressometer  not  only  en- 
ables us  to  get  equal  pressure  wlien  we  want  it, 
but  often,  as  importantly,  to  get  unequal  strain 
when  we  need  it. 

This  rule,  however,  is  not  alicat/s  ])ractical, 
as  in  temporary  cases,  where  the  alveolar  proc- 


158  Greene  Brothers'  Clinical  Course 

ess  is  to  become  much  absorbed.  Nor  is  it  ap- 
plicable wlien  small,  soft  spots  are  supported 
by  hard  ones  near  by.  Xevertheless  its  need 
is  so  frequent  and  use  so  grateful  that  it  might 
be  called  golden. 

VERIFYING  THE  NO=BITE. 

We  have  taken  our  still'bite  and  secured 
the  points  essential  to  setting  the  teeth  up  as 
we  want  them;  or  with  close  approximation 
to  it.  That  is,  we  guess  we  have  so  taken  it. 
Let  us  now  eliminate  the  guess*factor  from  it. 

To  be  certain  of  results,  we  must  verify  this 
no'bite  before  we  put  it  in  the  articulator;  for 
it  is  within  the  range  of  possibility  that  even 
in  our  tired=rest  short  bite  one  or  the  other  or 
both  of  our  bite=plates  may  have  slipped  on 
the  gums.    It  isn't  probable,  but  possible. 

Also  it  is  possible  tliat  the  lower  jaw  may 
have  moved  a  little  bit  laterally;  Avhich  would 
give  us  the  same  bad  occlusive  results.  Let 
us,  then,  even  mathematicize  our  proof*test. 

We  have  made  one  no^bite  at  jaw^tire  num- 
ber ten.  That  was  when  we  scribed-marked 
our  lower  bite'rim,  to  trim  it  off  even  with  the 
upper  one. 

Xow  if  we  can  have  two  or  three  more  of 
the  same  time-length,  and  they  all  register  alike, 
we  can  know  with  about  mathematical  certain- 
ty that  we  have  the  natural  position  and  rela- 
tion of  the  jaws  at  rest. 

MATHEMATICAL  TEST  OF  THE  NO=BITE. 

To  make  it,  Ave  '11  cut,  say,  three  test  V' 
shaped  notches  in  our  upper  bite-rim;  one  right 
in  the  front-center,  and  the  other  two — one  on 
each  side — about  the  place  of  the  first  molar. 
Then  give  the  command: 


IX   Dextal   Prosthesis.  159 

"Xow,  Madam,  I  want  you  to  give  me  an- 
other slow,  shortsbite,  just  the  same  as  you  did 
before.  Close  slowly  till  your  lips  touch  lightly, 
and  hold  the  plates  as  closely  together  as  you 
can  tcithout  toucliing.  You  now  know  how  to 
act  promptly. 

''One,  tico,  three,  four,  free,  sid\  seven,  eight, 
nine,  ten — snap!  Hold  now,  as  before,  till  I 
mark  again." 

I  this  time  make  a  perpendicular  mark  on 
the  lower  rim  immediately  opposite  the  very 
center  of  each  of  my  test^notches. 

Then  I  take  the  plates  out  of  the  mouth 
and  with  the  Kerr  tracing^stick  I  hot=drop  three 
small  test=knuckles  onto  the  lower  bite-rim  to 
fit  into  the  test  notches  above.  (Here  this  lit- 
tle fine  art  is  shown  i)ractically;  by  first  droj)- 
ping  a  molten  wee-bit  of  the  roll  tracing^stick 
onto  tlie  occluding  edge  of  the  lower  rim.  right 
op]>osite  the  mark  thereon,  and  pressing  it.  a 
little  bit,  into  its  mate^notch  on  the  upper  rim, 
thus  forming  a  test=knuckle. ) 

We  make  the  first  pair  of  notch=and=knuckles 
centrally  in  front;  then  one  on  either  side,  one 
at  a  time.  To  ])revent  sticking  together,  one 
or  the  other  of  the  plate=rims  is  dipped  into 
cool  water  the  instant  before  the  two  are  pressed 
together  (outside  the  mouth.)  We  then  trim 
off  any  little  side  surplus  about  the  knuckles, 
and  re=warm  and  press  back  together,  to  make 
sure  these  latter  knuckles  don't  interfere  with 
the  exact  coming  together  of  the  rims  hettceen 
them,  whicli  miglit  destroy  our  proper  stress, 
established  by  our  pressometer. 

This  fitting  the  knuckles  into  their  notches 
recjuires  care,  but  is  (juickly  done — yes,  in  one 
minute  of  time. 


160  Greene   Brothers'  Clinical  Course 

THE  THIRD   STILL=JAW  TEST. 

That  is  ticicc  now,  we  \e  tired  the  jaAV  at 
number  ten;  let  us  have  another  tired  bite  of 
the  same  duration;  this  time  to  see  whether 
or  not  the  test=knuckles  will  jibe  properly  to- 
gether into  their  match=notches  in  the  mouthy 
just  as  they  did  out  of  it. 

"Again,  Madam:  One,  two,  three,  four,  five, 
sia\  seven,  eight,  nine,  ten — bite!" 

If  the  knuckles  register  into  their  mate- 
notches  properly,  as  they  will  if  all  has  been 
done  carefully,  we  have  thus  taken  three  no* 
bites  at  three  different  times,  and  all  just  alike; 
and  no  error  or  doubt  about  it.  We  could  take 
more,  if  necessary,  to  please  a  surprised  Thom- 
as— and  sometimes  do  so. 

Once  I  had  a  "Smart  Alec"  insist  that  I 
couldn't  convince  hi?n  of  the  correctness  of  cuu/ 
bite,   or   "no*bite,"   no   matter   what   "proof"    I 


Fig.  IT. 

Fig.  17  Shows  testometers  in  position  between  impression- 
bite-plates.  The  pressure  test  is  made  with  the  "no-bite"  in  the 
mouth,  of  course. 


IN   Dental   Prosthesis.  161 

might  show;  as  he  had  been  "fooled  in  bites 
too  often." 

"Well,"  said  I,  "for  your  sake  I  '11  admit 
this  to  be  wrong;  not  uncertain,  but  tcrong. 
AVould  you  be  satisfied  if  I  could  set  up  a  set 
of  teeth  just  tliat  wrong,  with  their  cusps  and 
counter^sjjaces  knuckling  together  like  these, 
in  the  mouth?" 

"Yes,  I  tJteti  would  be  satisfied,"  said  he. 
So  I  proceeded  to  sliow  him  by  setting  up  the 
teeth.     And  that  is  wliat  I  will  now  do  for  you. 

TRANSFER  NO.BITE  TO  ARTICULATOR. 

We  must  now  transfer  the  no-bite  from  the 
mouth  to  the  articulator,  which  is  to  be  an  approx- 
imate representative  of  the  i^eal  anatomical,  bone* 
and-flesh  machine  itself. 

But  now,  before  I  leave  the  no=bite,  I  must 
say,  of  course,  in  the  remote  event  that  our 
notches  and  knuckles  sliould  fail  to  jibe  togeth- 
er in  the  last  tired=short=snap'test,  it  tcould  be 
because  one  or  more  of  the  times  the  bite'plates 
(one  or  the  other,  or  both)  did  slip;  or  else  be- 
cause the  lower  jaw  really  did  move,  in  some 
degree,  horizontally.  It  couldn't  be  otherwise. 
Then  I  'd  do  the  notchsandsknuckle  ^vork  over 
till  I  got  my  no=bite  test. 

ANATOMICAL  MOVEMENT  ON  THE  NO=BITE. 

If  I  have  what  I  call  a  "crip])le"  case,  I 
make  that  individual  mouth  its  oavu  articulator, 
in  a  ]jractical  sense.  By  a  "cripple"  case  I 
mean,  for  instance : 

(a)  A  prominent  "jimble^jaw"  of  extended 
mal=])rotrusion;  or, 

(h)    One  of  the  reverse,  retrusion :  or, 


III] 


1G2  Greene  Brothers'  Clixical  Course 

(c)  One  where  one  wing" of  the  maxillary  is 
much  longer  than  the  other ;  or, 

(d)  One  where  there  is  evident  erratic  move- 
ment on  the  "condyle  path,"  on  one  or  both 
sides  of  the  face;  or, 

(e)  One  where  the  hide*andsgo*seek  condyle 
socket,  needed  for  the  face=bow  measurement, 
is  so  covered  with  tissue  that  it  can't  be  located 
reliably,  as  a  starting=point;  or, 

(f)    One  where  other  mal* formation  or  mal= 
action  is  in  obvious  evidence. 

I  say:  In  such  cases  I  make  each  individual 
mouth  naturally  its  otvn  articulator,  either  wholly 
or  in  a  very  close  degree;  using  artificial  ma- 
chinery as  a  convenient,  approximate  assistant. 

A  "CRIPPLE"  MOUTH  ITS  OWN  ARTICULATOR, 
IN  THE  FINIS. 

To  do  this   (/.  c,  to  make    a   reed    automat- 
;  ic  articulation ) ,  I  take  my  completed    no  -  bite 
(sometimes  un=press=measured)   and  trim  about 
one*eighth  of  an  inch  off  the  top  of  the  lower 
bite^rim;   say,    from   the   second   bicuspid   rear- 
ward.    Then,  in  the  place  of  this  removed  ma- 
terial, I  fill=on  a  facing  mixture  of  plaster  and 
I    puhxrized  pumice-stone   (plaster  one  to  pumice 
j    three),  with  a  little  extra  fullness  on  top.     Fine 
molding-sand  with  plaster  is  good. 

This  soft^stone,  as  I  will  name  it,  is  frail 
enough  to  be  readily  worn  off  by  attrition. 

The  upper  bite^plate  stays  to  its  place,  and 
(by  my  several  improvements)  likewise  the  low- 
er one,  too.  Of  course,  these  stationary  con- 
ditions are  essential  to  the  operation. 

ISTow,  with  the  upper  bite'rim  cold  and  rigid, 
I  have  patient  chew=grind  the  two  bite=rims 
together    (the  upper  one  being  hard  modeling 


I 


IX   Dental   Prosthesis.  163 

compound)  with  the  natural  movement  of  her 
jaw,  until  the  soft^stone  facing  is  worn  down 
as  much  as  the  compound  in  front  of  it  will 
permit;  that  is,  to  genuine  anatomical  occlusal 
representation. 

(Some  of  my  enthusiastic  anatomical  friends 
may  rc'invent  this  little,  but  exceedingly  valu- 
able, Greene^point,  and  name  it  their  "Anatom- 
ical Grind'Stone  ^Method."  if  they  want  to.) 

Occasionally  this  anatomical  abrasion  of  the 
soft*stone  may  be  so  much  as  to  hinder  the 
l^lacing  of  the  no^bite  in  the  articulator  ^^ith 
convenience  and  certainty.  In  such  a  case, 
I  stick  a  thin  sheet  of  tin^foil  on  the  abraded 
soft=stone,  and  put  a  little  thin-like  plaster  on  the 
foil ;  and  then  have  patient  no=bite  lightly  straight 
down  on  the  plaster — this  time  without  lateral 
motion.  This  restores  the  lower  bitesrim  and 
enables  correct  arrangement  in  the  articulator. 

I  could  use  modeling  compound  instead  of 
l)laster  for  this  restoration  of  my  abraded  soft* 
stone,  but  it  might  get  too  hard  and  give  un- 
due pressure,  and  thus  spoil  the  accurate  effect 
of  the  occlusal  abrasion.  ^Medium  soft  plaster 
is  about  right. 

Understand:  the  only  use  for  the  soft  plas- 
ter restoration  is  for  convenience  and  safety  in 
transferring  the  no^bite  onto  the  articulator. 
When  setting  u})  the  teeth  (the  upper)  by  the 
guidance  of  the  lower  bitc'rim,  of  course  the 
plaster  level*up  is  first  removed,  then  the  teeth 
occluded  to  the  worn  abraded  soft=stone. 

We  '11  carry  out  the  rest  of  our  anatomical, 
occlusal,  guide'bite'abrasion  scheme  to  the  ulti- 
mate anatomical  occlusion  of  the  two  sets  of 
teeth  a  few  minutes  later  on. 

So  far  we  've  only  been  getting  ready  to 
use  our  artificial  articulator  first;  before  apply- 


164  Greene   Brothers'  Clinical  Course 

ing  the  newly  discovered  last  act  of  making 
a  cripple  mouth  its  oicu  articulator. 

(A  class=man  asks:  "Why  isn't  this  a  good 
way  to  take  anj^  other  than  a  "cripple"  case 
biter'  It  is,  but  it  's  not  often  necessary  where 
our  regular  no=bite  scheme  can  be  accomplished^ 
but  it's  never  amiss. ) 

Another  question:  "AVhy  not  use  some  sort 
of  hard,  thin  wax  base=plate  and  put  modeling 
compound  on  it  for  a  bite-rim  T'  That  's  our 
old  way.  You  can  do  it  if  yovi  can  get  a  well* 
fitting  basesplate:  essential  in  any  bite  method. 

As  for  that,  you  can  do  better  by  swaging  a 
metallic  bite==plate  and  using  a  modeling-com- 
pound  bite-rim  on  it.  You  can  tlien.  when  in 
the  articulator,  remove  the  compound  rim  and 
replace  it  witli  sticky  wax.  on  which  to  set  up 
the  teeth.  Any  bite=plate  that  will  stat/  to  place 
without  assistance. 

But,  if  you  make  the  "mouth  its  own  ar- 
ticulator," the  hitC'rim  must  be  of  material  that 
will  stand  the  natural,  automatic  grind=mashing 
maneuver;  which  is  done  first  in  the  bite — later, 
on  the  set-up  teeth  themselves. 

CORRECT  BITES  TILL  THEY  DO   TEST. 

If,  in  any  case,  our  no=bite  test  should,  from 
any  cause,  fail,  then  the  remedy  would,  of 
course,  be  to  do  it  over;  or  as  much  of  it  as 
necessary,  until  we  get  the  absolutely  "math- 
ematical" proof  we  need.  But  with  care  from 
the  start  you  '11,  indeed,  seldom  fail  to  make 
the  jibe^test  on  the  first  trial. 

But  right  here  let  me,  before  I  forget  it, 
run  l)ack  and  suggest  tliat  in  case  you  shouldn't 
liave  time  to  wait  and  make  models,  from  which 
to  take  bite=plate's  impression,  you  can  take 
them  directlv  from  the  mouth. 


IX  Dental  Prosthesis.  165 

That  is,  you  can  take  one  set  of  impres- 
sions for  making  vulcanizing  models  later  on, 
by  keeping  them  in  cold  storage  till  ready  to 
make  the  models.  And  then  you  can  take  an- 
other set  of  impressions,  and  take  the  no^bites 
on  them;  and  put  them  likewise  in  cold  water 
till  you  get  ready  to  make  your  models  and 
articulate  your  case,  weeks  or  months  later  on. 

Or,  you  can  take  your  no=bite  readily  without 
waiting  to  make  models,  by  using  the  impressions 
themselves  as  bitc'rims,  with  the  Greene=Kerr 
Removable  Handle  Impression  and  Bite  Trays 
— ^^as  I  '11  soon  show  you. 

FIRM  ARTICULATOR  IMPORTANT. 

As  to  articulators,  I  will  say:  Tliere  are  some 
good  ones  and  more  bad  ones.      My  objection      / 
is  to  those  of  needless    complication    and    bulk,     / 
and   those   that    are   flimsy    and   flexible;    espe- 
cially the  latter. 

I  find  articulators  very  much  like  inlay  ma- 
chines; some  are  perplexingly  ingenious  and 
others  ingeniously  simple.  And  the  funny  thing 
about  it  is  that  the  good  plain  and  complex 
ones  give  about  the  same  result,  if  properly 
operated,  from  a  tested  no=])ite. 

Anyhow  I  can  get  all  tlie  real  advantages 
in  a  simple,  light  but  strong,  plain,  old=style 
articulator,  by  a  little  im])rovement,  tliat  I  can 
make  in  a  few  minutes. 

The  only  exception  is  that  I  can't  open  or 
close  (widen  or  contract)  my  bite  after  in  the 
articulator.  But  by  my  advance^test  system 
I  never  need  nor  want  to  do  that. 

With  it  I  can  make  all  the  movements  the 
jaw  makes  in  actual  use.  It  is  the  pattern  I 
find  in  use    {minus  my  improvement)    in  nine- 


166  Greene  Brothers'  Clinical  Course 

tenths  of  all  the  dental  offices  I  visit;  hence  I 
use  it  mostly  in  my  demonstration.  But  this 
is  not  condemning  all  others,  at  all. 

The  essential  of  an  articulator  is  that  no 
])SiYt  of  it  can  move,  nor  especiall}^  spring,  with- 
out purpose  effort.  The  old  Bonwell  is  partic- 
ularly faulty  in  its  flimsmess  and  consequent 
liability  to  change  the  bite;  on  account  of  which 
so  many  failures  are  made  that  the  "springy 
old  thing"  has  been  generally  discarded  and 
junk=piled.  And  yet  the  faulty  Bonwell  is  good 
enough  in  the  hands  of  the  few  dentists  who 
persistently  self'train  themselves  in  exceeding 
carefulness. 

To  illustrate  tliis  important  weak  point,  I 
carry  with  me  an  old  plain=liner  with  its  upper 
jaw  so  weak  as  to  be  sprung  carelessly  and  thus 
change  the  set-up  teeth  from  the  accepted  bite, 
and  ruin  the  occlusion.  As  the  spring,,  by  care- 
lessness, is  usually  toward,  the  result  is  to  cause 
the  teeth  to  strike  together  first  at  the  heel, 
when  inserted  into  the  mouth. 

Well,  as  this  fault  applies  to  so  many  ar- 
ticulators, I  will  show  you  the  consequences 
later  on  in  this  lecture. 

I  will  add  here,  however,  that  as  I  am  not 
pecuniarily  interested  in  articulators,  and  as 
life  is  now^  too  short  (at  seventy-five)  to  enter 
the  "anatomical"  arena,  I  have  not  tried  all 
of  them.  But  among  the  simple  modern  ones 
I  have  used  and  seen  used,  with  satisfaction, 
is  the  "Kerr,"  made  by  the  Detroit  Dental 
^lanufacturing  Company.  The  untried  ones 
may  be  as  good. 

ARTICULATOR  IN  MOST  COMMON  USE. 

I  M'ill  here  make  my  demonstration  on  an 
improved   old-fashioned   plain*liner,   because   of 


IN  Dental  PRosTHEisis.  167 

its  simplicity  with  efficiency  and  because  of  its 
being  most  of  all  in  general  use  among  those 
who  take  ni}^  Course. 

In  placing  first  my  lower  model  on  the  lower 
jaw  of  my  articulator,  I  want  its  alveolar  face 
about  on  a  horizontal  plane  with  the  metal  jaw- 
under  it.  You  can  readily  so  trim,  or  thin  them 
down  so  ^vith  the  use  of  calipers.  And  my  ready* 
made  metal  models  are  generally  already  so 
trimmed.  (They  are  manufactured  by  the 
Detroit  Dental  jNIanufacturing  Company.) 

I  can  use  a  "face^bow"  to  get  the  model's 
forward  distance,  and  in  easy  cases  do  so. 

(Here  the  Snow  face-bow  and  its  applica- 
tions are  shown  when  requested;  also  the  dif- 
ficulties and  uncertainties  in  exceptional  "crip- 
ple" cases.) 

But,  upon  the  whole,  1  don't  find  it  really 
practical  any  further  than  to  help  in  getting 
the  "average"  of  the  measurement  claimed  for 
the  principle.  Rather  than  "argufy"  with  face* 
bow  enthusiasts,  I  would  save  time  and  admit 
ignorance  in  its  use.  Some  claim  for  it  infalli- 
bility in  all  cases. 

I  am  content  to  accept  the  average  the  anat- 
omists agree  on  as  to  the  actual  measurement 
of  the  dead.  This  average  measurement,  we 
are  told,  is  about  three  and  a  half  inches;  that 
is  to  say,  from  the  alveolar  ridge  center  in  front 
to  the  center  l)etween  the  two  condyle  sockets 
at  the  rear.  Well,  in  case  of  long  chinned  "Wil- 
son ian"  cases  call  it  four  Indies. 

Then  tlie  center  of  the  alveolar  ridge  of  our 
lower  model,  in  front,  should  be,  say,  three  and 
a  half  inches  from  the  cross-bar  of  our  articulator. 
So,  as  a  substitute  for  a  face'bow,  if  we  have 
none,    we   have   a   simple,    little,    narrow,    thin, 


168  Greexe   Brothers'  Clixical  Course 

flat  piece  of  wood,  three  and  a  half  to  four  inches 
long,  with  a  little  scallop  in  one  end  to  lit 
against  the  cross=bar. 

TO  FIX  LOWER  MODEL  ON  ARTICULATOR. 

To  adjust  this  model  on  the  articulator  read- 
ily, I  first  lay  the  latter's  lower  jaw  onto  a  piece 
of  paper  on  the  table;  then  pour  some  thin 
plaster  on  the  paper;  then  set  my  model  into 
this  soft  plaster,  and  apply  my  face-bow  sub- 
stitute. That  is  to  say,  I  set  the  scalloped  end 
of  it  against  the  cross-bar  of  my  articulator, 
and  slide  my  model  to  make  its  alveolar  front 
center  even  with  the  other  end. 

In  case  of  much  protrusion  or  retrusion  of 
lower  maxillary,  I  "make  allowances."  I  might 
and  might  not  come  nearer  to  anatomical  ex- 
actness by  face=bow  measurement.  But  these 
are  of  the  family  of  "cripple"  cases,  for  which 
we  hold  in  our  sleeve  a  last-resort  trick=taking 
card,  after  the  teeth  are  set  to  this  very  close 
approximation. 

After  the  lower  model  has  been  shoved  down 
on  a  plane  with  the  jaw  of  the  articulator  and 
fastened,  as  just  shown,  we  place  the  lower  bite* 
plate  onto  it  (the  model)  ;  then  the  upper  bite* 
plate  onto  the  lower  one,  with  the  aforesaid  jibing 
notches  and  knuckles  as  guides;  and  next  the 
upper  model  into  the  upper  bite*plate. 

Xext,  turn  the  upper  jaw  of  the  articulator 
over,  forward,  over  the  model,  not  quite  touch- 
ing it.  We  want  to  see  daylight  between  them, 
to  be  sure  there  is  no  metallic  strain  on  the 
model  to  tip  it.  Then  we  '11  peep  under  and  set 
the  guide*screw,  and  lock  it  firmly;  and  hold  up 
our  hand  to  the  avowed  certainty  that  it  can't 
tcork  loose.     Then   wet  the  back  of  the  upper 


IN  Dental  Prosthesis.  169 

model,  hold  it  down  into  its  bite-plate  firmly 
without  strain  on  articulator,  and  plaster  it  fast. 

Xow,  doctors,  the  practical  fact  is  you  can't 
get  your  bite  too  far  back  into  the  jaws  of  the 
old-line  articulators. 

Far  more  imj^ortant  than  the  "brand"  of  arti- 
culator is  the  essential  fact  that  your  bite=plate 
(which  should  be  preferably  of  modeling  com- 
pound) just  must  stay  to  place  on  the  ridges  and 
at  normal  plat c-icc firing-  stress,  when  taking  your 
so-called  bite. 

And  that  it  must  also  be  held  absolutely  to 
place  on  the  models  while  you  set  up  the  teeth. 

And  again  all  this,  especially  the  proper 
strain,  when  you  occlude  ("try  in'")  the  case  in 
the  moutli — "to  see.'" 

If  these  conditions  don't  all  obtain,  then  all 
scientific,  tine-spun,  high-tension  theories  about 
bites,  articulation  and  occlusion  nmst  fall  in  prac- 
tice. 

Furthermore  the  teeth  must  be  held  irremov- 
ably  to  place  in  their  investment,  in  the  flask, 
while  vulcanizing  and  cooling. 

Put  these  Greene  statements  into  your  pipe 
and  puff  the  smoke  at  all  enthusiastic  Occlusion- 
ists — in  my  name. 

BASE=PLATES. 

You  are  all  familiar  with  the  various  base* 
])lates  used.  I  presume  most  of  you  take  your 
bites  in  the  same  plate  on  which  you  set  up 
your  teetli,  and  call  it  a  "trial=plate.  " 

Well,  if  such  tits  snugli/  so  it  will  tirmly  hold 
onto  the  gums  without  help,  and  will  not  slide, 
that  will  do.  But,  if  it  should  move  at  all, 
which  it  is  liable  to  do,  especially  on  flat  gimis, 
the  result  is  the  same  as  if  a  wrong  bite  had  been 
taken. 


170  Greene   Brothers'  Clinical  Course 

Let  me  repeat  and  insist  that  the  base^plate 
onto  which  you  sticky*wax  your  teeth  must  fit 
down  close  to  the  model  all  over  and  not  come 
loose.  Fasten  it  to  the  model  with  compound 
round  the  edges.  All  this  to  avoid  too  thick  plate 
and  mal=occlusion. 

THE  BASE=PLATE. 

There  are  different  kinds  of  base= plates  and 
different  ways  of  using  them.  Formerly  I  taught 
how  to  make  and  use  a  "dip=base=plate." 

I  formed  it  onto  my  model  by  first  m  etting 
the  model  and  then  quick=dipping  it  into  melted 
basc'plate  wax,  twice  or  three  times,  until  I  got 
it  to  be  the  thickness  I  wanted  my  teeth*plate  to 
be. 

It  had  the  advantage  of  adhering  closely  to 
the  model  all  over;  and  of  being  the  thickness  of 
my  coming  plate.  But  there  was  a  disadvantage 
in  taking  it  off*and'On  model — too  soft. 

But  in  later  years  I  have  found  just  what  I 
want  in  the  "Perfection"  base^j^late  made  by  the 
Detroit  Dental  ^Ifg.  Co.  It  is  one  of  the  shellac 
nature;  strong,  smooth,  hard  when  cool,  and  just 
the  thickness  for  an  upper  vulcanite  plate. 

After  removing  my  hiie'plaie  from  the  model 
I  fit  the  Kerr  base=plate  to  it  in  this  way:  I  first 
warm  the  model  slightly  in  a  shallow  pan  of 
warm  water.  And  M'hile  in  the  water  thumb*and« 
finger=press  the  also  warmed  base*plate  down 
onto  the  warm  model  luitil  tlie  former  approxi- 
mately fits  the  latter.  Tlien  I  lift  the  base-plate, 
stiff  enough  to  handle,  and  scissor  it  off  closely 
to  the  mark-line  made  by  tlie  margin  of  the 
model*impressed  onto  it. 

This  gives  me  the  exact  extent  (height  and 
length)  of  my  coming  plate*tosbe.     Xow  before 


IN  Dental   Prosthesis.  171 

cooling  I  return  it  back  onto  the  model,  in  the 
water,  and  press  it  to  the  same  until  it  fits  closely 
all  over.  By  holding  it  in  the  water  to  do  this 
the  base-plate  won't  rebound  and  spring  away 
from  the  model  in  cooling. 

Well,  now,  to  prevent  splitting  in  the  roof 
during  my  handling  I  "11  fit  a  small  stiff  wire  into 
it  across  and  close  to  the  rear,  by  heating  the  wire 
and  pressing  it  into  the  base^plate. 

In  cases  of  very  deep  arches  I  sometimes  have 
to  thicken  my  Perfection  by  adding  another 
sheet  onto  the  thin  place.  To  weld  this  base' 
plate  heat  both  bodies  when  dry  and  press  to- 
gether and  smooth  down. 

SETTING  UP  TEETH  ON  BASE=PLATE. 

Before  we  removed  the  upper  bite^plate  from 
its  model  on  the  articulator,  we  sealed  or  clinched 
it  fast  onto  the  model  with  cleats  of  modeling 
compound,  to  hold  it  firmly  to  its  right  place 
thereon.  And  that  right  place  was  made  mani- 
fest by  closely  observing  the  notch=knuckle  fit* 
together  of  the  two  bite-rims.  A  mis=jibe  would 
show  the  lower  bite*plate  misplaced  on  its  mod- 
el; the  equivalent  of  a  mal^bite,  you  see. 

Then  we  fitted  oin*  base==plate  to  the  model  as 
just  described. 

Xow  we  '11  prepare  to  set  the  teeth  onto  our 
smooth  basesplate.  We  '11  make  a  little  roll,  or 
bar,  of  sticky- wax  about  the  diameter  of  a  very 
large  goose-quill,  and  warm  it  and  stick  it  onto 
the  base-plate  over  the  ridge  of  the  model.  We 
now  use  the  Greene  sticky  wax. 

Onto  this  roll  of  sticky^wax  we  '11  hurriedly, 
but  approximately,  adjust  the  teeth;  carefully 
heating  the  pins  in  each  tooth  by  the  side  of 
oin*  spirit  flame,  to  assure  adherence  to  the  wax. 


172  Greene  Brothers'  Clinical  Course 

We  '11  begin  with  the  central  incisors  and 
get  them  properly  located;  then  work  on  back, 
one  by  one,  to  the  last  molar.  If  a  little  time 
is  important,  this  can  all  be  done  in  two  or 
three  minutes.  Then  warming  the  sticky=wax 
and  the  teeth  thereon,  we  close  the  articulator 
and  simply  press  the  approximately  arranged 
teetli  down  onto  the  lower  bite=rim,  for  length, 
and  out  even  with  its  outer  edge  for  prominence. 
The  fixity  of  the  guide=screw  holds  the  jaws  to 
right  distance  apart;  and,  if  nothing  sprung^  the 
teeth  have  taken  the  precise  position  of  the 
removed  upper  bite=rim.  We  saw  that  in  the 
mouth  and  satisfied  ourselves  then  as  to  its 
show=length  and  fullness — we  will  not  doubt 
it  now. 

To  thus  finally  adjust  an  approximately  ar- 
ranged upper  set  of  teeth  requires  from  two 
to  three  minutes. 

(The  art  and  manipulation  of  thus  quickh/ 
setting  up  teeth  by  a  guide^rim,  regulated,  by 
a  guide=screw,  is  shown  in  detail  and  with  spe- 
cial interest  in  our  verbal  Course.) 

The  heavy,  cumbersome,  complicated  artic- 
ulators are  not  the  best  adapted  to  this  work. 
Xor  are  the  weak,  flexible  ones  at  all.  If  you 
use  flimsy  ones,  re^inforce  their  weak  parts,  by 
brazing  on  more  metal.  Don't  rely  on  even  your 
own  carefulness  in  their  use  without  strengthen- 
ing them. 

Xow  your  upper  teeth  are  "occluded"  down 
onto  your  lower  bite*rim. 

Go  on  and  waLV  up  to  suit  i/ou;  bearing  in 
mind  that  at  the  upper  edge  of  your  base=plate 
the  fullness  is  already  correct.  You  took  your 
impression  with  proper  fullness  which  settled 
that. 


IN  Dental  Prosthesis.  173 

Next  remove  j'^our  lower  bite^plate  off  of  its 
model,  put  on  your  lower  base^plate,  same  as 
you  did  the  upper;  and  the  sticky^wax  on  it  as 
before. 

And  then  the  lower  teeth  approximately  onto 
the  sticky-wax  as  before.  And  then  adjust  them 
to  the  cooled  upper  ones  as  you  want  them. 

And  then  wax'up  the  whole  lower  case  as  you 
want  it;  of  course  all  this  time  watching  your 
guide=check  screw  underneath  so  as  not  to  change 
your  bite.  And  as  I've  before  cautioned  you: 
don't  spring  the  jaw  of  your  articulator  in  oc- 
cluding j^our  teeth. 

After  you  have  set  j^our  teeth  up  thus  you 
can  change  the  position  of  the  front  ones  as  you 
])lease,  even  after  setting  them  up  to  their  ojipos- 
ing  guide*rim  or  opposing  teeth. 

And,  to  appear  natural  they  often,  if  not  gen- 
erally, sliould  l)e  more  or  less  irregularly  spaced 
and  stationed.  Only  beware  of  any  alteration  in 
the  length  of  the  jaw  teeth,  after  once  set  up  to  a 
Greene  no=bite.  They  are  the  fixed  corner^ 
stones  of  the  tested  relation  of  the  natural  jaws. 

But  as  to  the  front  teeth :  you  can  set  or  re-set 
them  higher  or  lower.  You  can  space  them  apart 
as  far  as  you  wish ;  lean  them  outward  or  inward, 
or  turn  them  around  in  the  sticky*wax. 

You  can  regulate  or  irregulate  them  at  will, 
so  long  as  you  don't  change  the  guide=screw  nor 
disregard  it. 

Your  full,  double  case  is  now  waxed  up. 

TRYING  TEETH  IN  THE  MOUTH. 

Xow  if  you  fear  you  liave  missed  any  thing 
as  to  tile  impression  (whicli  is  hardly  probable  if 
you  have  carried  out  these  instructions)  you  can 
take  the  waxed^up  teeth  off  of  their  models  in  the 


174  Greene  Brothers'  Clinical  Course 

articulator  and  "try  them  in  the  mouth."  They 
are  ready  for  it,  now. 

But  right  here  you  make  a  blunder  worse 
than  to  take  the  chances  of  not  trying  them  in, 
but  leaving  them  on  their  models.  Whether  you 
make  any  change  or  not  in  the  mouth  be  dead 
sure  you  get  your  set-up  teeth  back  onto  their 
models  exactly  as  they  were  before  removal. 

Whatever  you  may  spring  your  basc'plates, 
or  move  a  tooth  or  lack  of  absolutely  correct  re- 
placement onto  the  models  just  so  far  will  your 
occlusion  be  off  in  your  finished  dentures.  You 
can  readily  see  that. 

But,  my  dear  doctors,  even  should  you  steer 
clear  of  all  displacement  of  the  teeth  on  the  sticky 
wax,  and  should  you  get  the  plates  back  onto 
their  models  exactly  as  before  removal  you  still 
have  a  dangerous  gauntlet  to  run — several  of 
them. 

IMPORTANCE  OF  STRESS. 

Think  a  little,  doctors ;  you  took  your  impres- 
sion at  a  given  stress  on  the  soft  tissues — so 
seldom  considered  by  dentists.  You  made  your 
model  and  then  fitted  your  base^plate  to  it  at  this 
same  strain. 

Then  you  took  your  bite  at  more  than  proba- 
bly another  strain  and  set  up  your  teeth  at  this 
strain  on  the  gums. 

Then  you  "tried  the  teeth  in  the  mouth"  and 
if  at  all  probably  re*ad justed  them  onto  the  gums 
at  still  anothersstressspressure.  So,  even  tho'  you 
got  your  plates  back  onto  tlie  models  as  they  were 
before  there  still  may  be  a  conflict  of  two  or  three 
different  tissue  strains  to  contend  with  in  the 
case. 

Xow  if  you  '11  think  a  moment  you  '11  see 
what  a  conflict  of  tissue  strain  may  mean.    If  vou 


IX   Dental   Prosthesis.  175 

want  to  see  what  it  may  mean  in  occlusion  select 
you  a  mouth  with  soft  tissues — say  an  upper  case 
(a  soft  lower  one  would  be  still  worse.) 

Take  your  impression  lightly  with  soft  plas- 
ter. ]\Iake  your  model  and  make  your  bite^plate 
on  it.  And  then  take  a  hard  pressure  bite:  and 
set  your  teeth  up  to  this  hard  bite.  Then  try  your 
case  in  the  mouth ! 

It  will  lack  just  as  much  of  occluding  in  the 
mouth  as  was  the  difference  between  the  tissue 
strain  of  the  impression  and  the  bite.  Wherever 
the  tissues  gaxe  way  most  in  the  straining  there 
will  the  teeth  strike  together  first  when  denture 
is  finished. 

In  sucli  cases  it  may  take  a  whole  lot  of 
after-grinding  to  even  passably  occlude  the  teeth 
in  the  mouth,  and  indeed  the  difference  may  be  so 
much,  here  and  there,  they  can't  be  ground 
enough  to  occlude  them. 

Now,  doctors,  after  a  little  side-lecture  on 
prosthetic  quackery  we'll  return  to  our  case  right 
here  where  we  left  it.  We  'II  shotc  yon  a  way 
out  of  all  such  trouhlc. 

SIDE  REMARKS— PROSTHETIC  QUACKERY. 

And,  my  dear  doctors,  I  will  here  beg  par- 
don for  a  little  side  lecture,  to  insist  that  by 
far  the  most  dentists  set  up  their  teeth  too  reg- 
ular to  look  natural  or  artistic.  The  distaste- 
ful custom  is  to  use  white  teeth  and  set  them 
up  for  the  mouth  to  imitate  ])uttons  on  a  paste- 
board, or  tombstones  in  a  national  cemetery. 

The  result  is  that  most  wearers  of  artificial 
teeth  look  like  ghosts  grinning  through  moon= 
shine. 

It  is  as  much  of  a  professional  disgrace,  or 
more,  for  ethical  dentists  to  let  their  foolish  pa- 
tients force  them  to  do  inartistic  work  and  ])er- 


176  Greene  Brothers'  Clinical  Course 

form  unethical  operations,  as  it  is  for  an  ad- 
mitted unethical  quack  to  do  the  same  thing 
through  ignorance  or  greed.  Hard  to  say,  but 
needs  no  proof. 

Dental  ethics!  Humph!  I  have  known  scores 
of  the  so-called  "best  men"  to  argue  learnedly 
and  truthfully  with  their  patients  against  the 
quackery  and  wrong  of  sacrificing  natural  teeth 
and  then  finally  give  up  and  sacrifice  them  them- 
selves; to  do,  I  might  say,  their  part  to  teach 
that  their  calling  is  no  profession  after  all. 

Dental  ethics:'  Almost  every  week,  and  fre- 
quently oftener,  I  see  mouths  of  good,  or  fairly 
good,  natural  teeth  cijdoncd  to  make  room  for 
httle,  white,  glossy  substitutes,  to  be  jammed 
closely  together  in  straight,  even  button*rows. 
Xor  do  I  have  to  go  to  an  "advertising  joint," 
or  "artificial^tooth  shop,"  to  see  this. 

Then,  is  it  any  wonder  that  the  really  most 
difficult  and  highest  art  in  dentistry  is  simken 
to  the  lowest  grade  in  dental  trade,  when  a  ma- 
jority of  even  college  graduates  will  thus  "ac- 
commodate" the  whims  and  ignorant  prejudices 
of  their  so-called  patients? 

Then,  for  the  dignity  of  your  almost  sacred 
calling,  both  select  and  set  your  teeth  in  har- 
mony with  physiognomy  and  age;  yes,  age  of 
your  patrons.  Stand  in  front  of  the  dignity  of 
your  scientific  profession;  at  least,  as  an  eth- 
ical scientific  horse  shoer  does.  You  can't  hire 
him  to  shoe  even  a  mule  wrongly;  nor  scare 
him  with  threats  to  go  to  his  quack  competitor. 

It  is  legitimate  license  to  improve  features, 
but  you  will  never  do  it  by  such  contrasts  and 
inharmony  as  little,  M'hite  teeth,  evenly  set  in 
an  old  grandma's  mouth. 

You  might  as  well  put  a  short  white  skirt- 
let,  white  frilled  pantelettes  and  sailor  hat  on 


IN  Dental  Prosthesis.  177 

lier,   and  braid   her  hair   with   flowing   ribbons 
down  behind,  to  "make  her  look  young." 

Now,  do  you  know  of  any  professional  mod- 
iste who  would  risk  her  reputation  and  dis- 
grace her  calling  like  that?  Wouldn't  she  tell 
a  patron  with  such  taste  to  go  to — to  some 
quack  for  accommodation? 

WEIGHTED  MODELING  COMPOUND  BITE=RIM. 

In  most  cases  it  is  practical  and  I  like  to  set 
the  lower  teeth  up  directly  on  the  lower  bitC' 
plate,  or  rim,  of  shot*weighted  modeling  com- 
23ound,  for  weighty  reasons;  one  being  that  I 
save  time  in  not  making  a  lower  base-plate. 

I  do  this  by  shaving  off  some  of  the  outside 
compound  and  tracing  sticky=wax  in  its  place, 
whereon  to  stick  the  teeth.  Another  reason  for 
weighted  compound  is  that  weight  helps  to  hold 
it  down  to  place  in  all  operations  connected  with 
it. 

In  using  the  weighted  compound  bite^rim,  to 
set  the  teeth  on,  be  sui*e  and  stiffen  it  with  wire 
all  around  the  lingual  side. 

And  on  waxing  and  shaping  up  a  lowei-  case, 
for  flasking,  always  do  all  and  everythmg  on  it, 
instead  of  leaving  it  to  be  done  on  the  vulcanized 
denture.  And  make  sure  to  scrape  out  on  the 
Hngual  side  a  good  and  grateful  tongue  scallop 
— most  important  point  in  a  lower  plate. 

y  And  here  is  the  '"time  and  place"  to  trace-on, 
with  stickyswax,  the  new  (Greene  "Joker,"  or 
tongue^rest,  to  broaden  the  lateral  lingual  reach 
of  your  plate-to5l)e,  to  give  it  more  area  of  con- 
tact, for  suction.  Don't  extend  it  more  than 
one-eighth  inch,  nor  make  the  plate  any  deeper. 
And  don't  put  it  in  fi-ont. 

Say,  doctors,  when  you  get  to  using  weight 
in  lower  bite-i)lates  and  base-plates,  you'll  feel. 


178  Greene   Brothers'  Clinical  Course 

and  do,  as  tlie  tenants  of  the  Duke  of  Argyle 
once   did. 

He  advertised  for  the  l)est  way  to  make  them 
grateful  and  to  praise  him,  and  the  result  was 
that  he  put  up  back=scratching  posts  at  close 
convenience  all  over  his  estate.  Then  all  the  ])eo- 
ple  scratched  their  backs  every  day  and  grate- 
fully rejoiced  aloud:  "Blessed  be  tlie  Duke  of 
Argyle!" 

l^ea,  doctors,  in  severely  needful  cases  you 
may  catch  their  spirit  and  put  up  great  sound' 
boards  to  re-echo:  "Blessed  be  the  cranky  old 
farmer  dentist  from  the  'Show=me'  State."  If 
you  don't,  you'll  be  ungrateful  for  this  $]00 
])()inter.  (A  class=man:  (xive  us  more  about  the 
"joker.'")  All  right,  I'll  give  you  more.  AV'elJ, 
to  make  room  for  this  accommodating  lingual 
support,  the  jaw  teeth  sliould  l)e  somewliat  high, 
or  long;  and,  that  they  may  be  so,  the  toucliing 
ones  above  must  be  correspondingly  short.  The 
rule,  then,  is  to  range  tlie  upper  molars  rather 
upwards  and  make  the  last  one  about  as  short 
as  you  well  can;  then,  of  course,  bring  up  the 
opposite  lower  ones  to  correspond. 

The  exception  would  be  when  the  upper  jaw 
teeth  need  to  be  long,  to  hold  the  cheeks  out. 
But,  nevertheless,  long  molars,  especially  long 
last '  molars,  are  detrimental  to  comfortable 
wearing  of  upper  dentures,  anyhow. 

Dr.  Geo.  A.  Wilson,  the  eminent  prosthetic 
specialist,  of  Cleveland,  Ohio,  contends  that  the 
up^turn  in  the  range  of  an  upper  set  of  teeth 
should  be  confined  to  the  final  molar;  leaving 
the  rest  on  a  plain,  occlusal  line.  And,  strictly 
speaking,  philosophicalh)  he  is  probably  correct. 
I  can't  say  anatomically  correct,  for  anatomies 
vary  much  in  this  respect. 


I 


IX  Dental  Prosthesis.  179 

STILL  MORE  ABOUT  THE  "JOKER." 

There  are  some  cases  where  the  lowei-  teeth, 
for  one  or  more  reasons,  can't  be  made  long 
enough  to  provide  ample  space  for  a  sufficient 
cut-away  for  such  frictional  tongue  support,  our 
tongue  scallop.  In  such  cases,  1  come  to  the 
rescue  with  a  universal,  ne  plus  ultra  ''joker." 

This  consists  of  a  narrow,  lateral  addition 
to  the  lingual  edge  of  the  lower  plate  on  both 
sides  of  the  mouth — not  in  front. 

By  vulcanizing  (if  a  rubber  plate)  such  an 
extension  to  the  ])late,  at  right  angle  with  its 
lingual  walls,  and  then  scalloping  out  some  from 
both  the  wall  and  extension,  a  sufficient  tongue* 
rest  can  be  made,  in  almost  any  case,  to  hold 
down  a  lower  denture;  even  if  it  had  no  other 
means  of  retention.  Of  course,  the  extension 
should  be  made  and  the  scraping  done  in  tlie 
wax;  never  much  in  the  vulcanite  plate. 

However,  in  swaged  or  cast  metal  plates,  pro- 
vision should  be  made  for  the  joker  first  in  the 
impression,  and  conseqeuntli/  on  the  model;  a 
stunt  requiring  skill,  experience  and  persistence. 

ANOTHER  REASON  FOR  THE  JOKER. 

Another  Aaluablc  advantage  in  the  joker, 
other  than  its  ])roviding  means  for  tongue  force, 
IS  that  it  adds  area  to  atmospheric  contact  and 
thereby  helps  to  give  the  denture  more  so=called 
"suction."  But  beware  of  adding  depth  to  the 
plate's  edge,  which  was  settled  in  the  impres- 
sion, in  the  outstart.     (See  Index  V.) 

It  must  extend  laterally,  and  sometimes  a 
little  angling  upward,  to  accommodate  a  roll  of 
soft,  moving  tissue  under  the  tongue. 

When  the  joker  is  properly  adjusted,  it  sets, 
in  normal  cases,  do\m  onto  and  into  the  sublin- 


180  Greene  Brothers'  Clinical  Course 

gual  saliva  bed,  ever  present  in  healthy  mouths, 
giving  the  plate  the  action  of  a  duck's  web* 
foot  in  a  mud=puddle.  Without  it,  such  a  plate 
might  be  as  a  chicken's  Avebless  foot  easily 
working  up'and^down  in  water. 

The  joker  should  extend  in  length,  say,  from 
about  the  anterior  of  the  first  bicuspid  to  the 
posterior  of  the  second  molar;  and  in  width, 
say,  oneseighth  to  three=sixteenths  of  an  inch  in 
the  center,  rounding  off  gradually  to  the  ends. 

While  I  advise  usually  about  this  width  for 
this  tongue=rest  extension,  I  have  put  them  on 
twice  as  wide,  with  little  or  no  discomfort  to 
the  M'carer. 

In  one  case,  a  dentist  misunderstood  me 
and  made  the  extension  half  an  inch  wide. 
His  report,  a  month  later,  was  that  his  patient 
"kicked  like  a  bay  steer  for  ten  days";  but  aft- 
er he  had  "cured"  ("tanned")  her  mouth  with 
white«oak=bark  ooze,  it  got  well;  and  "the  plate 
sucked  down  like  a  goose's  foot  in  mire." 

THE  JOKER  A  NEW  IDEA. 

The  idea  of  a  tongue  scallop  is  not  wholly 
new,  though  the  scheme  never  has  been  prac- 
tically introduced  to  much  extent  until  this 
private  Course  of  Instruction  has  been  before 
the  dentists  in  a  number  of  States,  mostly  in 
the  far  West  and  mid^West ;  now  about  fourteen 
years. 

But  the  idea  of  a  lateral  extension  to  the 
lingual  rim  of  a  lower  denture,  to  set  onto 
and  into  the  saliva  pool  under  the  tongue,  and 
thereby  cause  suction,  and  to  furnish  leverage 
for  the  tongue  for  mechanical  power,  is  original 
ill  this  Course,  so  far  as  I  know. 

And  I  remember  that  it  took  years  to  de- 
velop   active    courage    from   the    inspiration    to 


IN  Dextal  Prosthesis.  181 

warrant  a  trial  of  the  theory.  Aiid  I  remem- 
ber how  a  few  sore  mouths  ahnost  frightened 
me  for  a  while  away  from  this  most  practical 
of  simple  prosthetic  improvements. 

It  is  a  simple  matter  to  scoop  out  tongue^ 
rest  room  in  modeling  compound  or  wax;  and 
no  difficult  one  to  add  the  joker  in  wax  in 
"waxing*up.'  But  care  must  be  taken  to  do 
it  all  philosophically;  and  especially  to  finish  so 
as  to  leave  no  roughness  whatever. 

And  even  at  the  best  the  mouth  will  some- 
times require  astringent  treatment,  taking  time 
to  "tan"  the  parts  so  as  to  immune  them  from 
frictional  soreness. 

Among  the  numerous  astringent  remedies  I 
liave  used  to  treat  sore  mouths  and  "tan"  the 
membrane  to  immune  it  from  tenderness,  I 
have  found  nothing  less  disagreeable  nor  more 
successful  than  simple  oak=bark  ooze;  that  is, 
reduced  tea  from,  preferably,  white=oak  bark, 
with  a  very  little  essential  oil  of  some  sort  in 
it  to  prevent  fermentation. 

But,  withal,  the  joker  is  the  card  that  zcins, 
even  when  all  others  fail,  to  hold  a  lower  plate 
in  place  sufficiently  for  practical  use.  (In  five 
years  a  thousand  men  will  probably  claim  its 
invention.) 

But  don't  get  the  idea,  as  some  have  done, 
that  my  joker  is  an  attachment  to  the  plate. 
It  is  simply  an  extension,  of  the  same  material. 

THE  LATERAL,   OR  "SHEEP=BITE,"  MOVEMENT. 

Well,  here  we  have  a  full  set  of  real  teeth 
Ave've  set  up  by  our  no=})ite  rims  in  this  Old 
PlainsIJne  Articulator.  T  use  it  for  its  sim- 
plicity and  popularity. 

We  first  set  the  upj^er  ones  to  the  lower 
bite^rim.      Then  we  set  tlie  lower  ones  to  the 


182  Greene  Brothers'  Clinical  Course 

upper  ones.  They  come  together,  as  a  whole, 
just  exactly  as  our  no^bite  rims  representing 
them  did,  "compensating  curve"  and  all. 

But  so  far  we  have  only  a  square,  perpen- 
dicular strike;  at  least,  without  any  knoicu  close' 
occluding  horizontal  fit.  But,  in  crush=grind- 
ing,  the  lower  jaw,  you  know,  has  a  little  lat- 
eral motion;  sometimes  nicknamed  the  "sheep- 
bite,"  and  the  "quid=bite." 

While  this  lateral  motion  is  never  as  ex- 
treme in  the  mouth  as  is  generally  shown  as  a 
possible  movement  of  patent  articulators,  it  is 
always  there,  to  some  extent,  in  uriimpeded 
natural  masticatory  action.  And,  of  course^ 
artificial  teeth  should  be  adjusted  to  accommo- 
date the  full  natural  side-grinding  action.  The 
wearer  will  seldom  get  the  ])est  without,  say, 
an  eighth  of  an  inch  sideways  play. 

Now,  the  question  is:  How  best  to  get  this 
natural,  lateral  motion  in  an  artificial  denture? 

The  claim  for  numerous  articulators  on  the 
market  is  that  they  impart  this  and  all  other 
natural  movements  exactly  to  the  artificial  den- 
ture, including  the  anatomical  relations  of  the 
teeth.     This  is  indeed  well. 

But  granting  the  competency  of  the  ma- 
chinery itself,  there  is  a  problematic  combi- 
nation of  ticklish  factors  in  the  way  of  prac- 
tical application.  So  the  exact  transference 
"depends." 

It  depends  on  (a)  whether  or  not  the  dent- 
ist has  the  exact  natural  bite — very  doubtful 
by  usual  methods:  and  (h)  whether  he  has  this 
exact  natural  bite  on  the  articulators  exactly 
as  it  was  when  tested  in  the  mouth;  and  (c) 
whether  he  knows  the  exact  movements  of 
that   particular  jaw;  and    (d)    whether  he  sets 


IX   Dextal   Prosthesis.  183 

his  machinery  exactly  to  those  (pro})ably  vary- 
ing and  erratic)  movements. 

I  don't  mention  these  problematic  points 
to  hyper*criticize  claimants  for  perfect  anatom- 
ical articnlation  and  occlusion,  who  so  seldom 
give  all  these  essential  facts  in  their  case.  I 
do  it  to  put  you  on  your  guard  in  the  use  of 
an  I)  articulating  device. 

Whether  true  or  not,  I'll  here  assume  they 
can't  (for  I  can't)  always  organize  all  these 
factors  into  practical  operation  for  the  exact- 
ness claimed.  We'll  then  go  on  and  do  at 
least  the  next  best  thing,  under  the  circum- 
stances. We'll  make  the  closest  approxima- 
tion that  artificial  machinery  can  provide,  and 
then  make  the  jaw  itself  its  own  articulator 
in  the  finis. 

THE  COMMON,  OLD  PLAIN=LINE  ARTICULATOR 
IMPROVED  FOR  ANATOMIC  WORK. 

I  have  here  an  old  plain=line  articulator  that 
I  have  so  im])roved  as  to  give,  I  think,  as  ap- 
proximately the  average  anatomical  movements 
of  the  natural  jaw  as  any  Fve  seen. 

You'll  huigh  when  you  see  the  plain,  humble,, 
slandered  old  lady  in  fashionable  dress  and  in 
service  on  the  modern  anatomical  stage.  Why, 
she's  joined  the  Leetnre  Bureau!  My!  isn't  it 
a  bou(piet=deserving  achievement  to  have  "dis- 
covered" the  mud-covered  old  diamond! 

See  here,  doctors,  with  this  native  cross-bar 
she  shows  her  plain  o})en'and=shut,  unassum- 
ing j)osition;  her  straight  up-and-down  way  of 
doing.    That's  "before  taken." 

Xow,  look  again!  By  a  simi)le  twist  of  my 
fingers  I'll  remove  her  old  tight=jacket  cross= 
bar  and  insert  a  freer  (smaller)  base  of  action; 
a   simple,   common   8=])enny  nail   that    I    found 


184  Greene  Brothers'  Clinical  Course 

on  the  sidewalk,  trampled  in  the  dust  of  hu- 
miliation by  the  thoughtless  multitude — only 
an  8=2Denny  nail,  rusty  from  ill=treatment,  neg- 
lect, and  inactivity. 

But  humble  as  the  common  nail  is,  it  en- 
ables Madam  Old  Plain  Line?'  to  sweep  the  ana- 
tomical horizon  to  the  right  and  to  the  left  in 
graceful,  competitive  waltz. 

What  an  honor  to  the  down-trodden  old 
nail  to  have  enabled  the  long'guyed  old  ]Madam 
to  impart  such  lateral  "sheep-=bite"  benefit  to 
toothless  humanity ! 

Well,  let  's  stop  praise,  and  ask  the  old 
thing  to  prove  she  's  from  ]Missouri  by  "show- 
ing" us.  I'll  be  her  humble  servant.  Watch 
me.  I  '11  baptize  her  upper  jaw,  teeth  and  all, 
"into"  cold  water.  Then  I  '11  give  the  teeth 
of  her  lower  jaw  a  warm  reception  over  our 
cheerful  spirit=lamp  till  they  are  ready  to  move 
in  the  right  direction. 

See!  Xow  I  clasp  my  Mhole  left  hand  firm- 
ly over  her  cold  upper  jaw  and  hold  it  tightly 
all  around;  then  fully  clasp  her  more  tractable 
louver  jaw,  in  tlie  same  way,  with  my  right 
hand — 'that  lifted  the  lost  nail  from  the  mire  and 
the  clay  to  glorious  usefulness. 

With  the  upper  teeth  cold  and  set  in  stolid 
firmness,  and  the  lower  ones  warm  and  willing 
to  yield  to  their  superiors,  under  pressing  cir- 
cimistances,  I  '11  give  the  command  to  "Side- 
wiggle!"  And  all  on  a  sudden  the  teeth  be- 
low have  "exactly"  Avaltzed  themselves  toward 
those  above  them,  to  practical  anatomical  jux- 
taposition— if  we  've  watched  the  set=screw  and 
haven't  bent  the  metal  jaw.  We  now  have 
lateral  occlusion,  also. 

But  the  action  of  ]Madam  Plain'Liner  isn't 
up=tosdate  yet.    She  must  now  set  her  face  in 


IX  Dextal  Prosthesis.  185 

another  direction.      I'll  further  help  her   up  in 
the  2^opular  anatomical  world.     Watch  me  close 

this  time. 

THE  FORWARD  BITE  MOVEMENT. 

I  '11  take  a  small,  parallel=round  mouse-tail 
file,  the  size  of  a  6*penny  nail,  and  make  a  small 
"condyle  path,"  or  slot,  running  out  from  each 
one  of  the  four  cross-bar  holes,  at  regulation 
angle;  on  both  sides  of  the  articulator,  of  course. 

These  slots  extend  out  about  one-sixteenth 
of  an  inch  from  the  main  cross-bar  holes;  those 
in  the  upper  jaw  extending  forward  and  those 
in  the  under  jaw  rearward.  The  two  condyle 
slots  (a  i)air)  together  in  action  give  the  lower 
jaw  a  range=reach  of,  say,  one^eighth  of  an  inch; 
or  more,  if  wanted.  And  as  much  more  as  you 
Mant,  according  to  depth  of  slot. 

So  with  a  still  smaller  nail,  a  6=penny,  that 
will  move  in  the  newly  provided  "condyle  path.  ' 
she  can  now  reach  out  and  bite  cud  to  on  her 
front  teeth — ^like  "Suz^an  ]Moriah"  could. 

We  peep  imder  and  see  that  our  '"compen- 
sating curve."  made  for  other  purposes,  and 
incidentally  for  this  occasion,  is  intact.  The 
rear  molars  still  hit  together  "automatically." 
By  further  extending  our  little-nail  slots,  3Iad- 
am  Plain=Liner  could  make  just  as  exaggerated 
protruding  movements  as  any  of  her  competi- 
tors. But  she  doesn't  care  to  distort  merely  to 
show  off  possibilities. 

EACH  MOUTH  ITS  OWN  ARTICULATOR  IN  THE  FINIS 
FURTHER  ILLUSTRATED. 

Well,  now,  if  we  want  the  exquisite  of  nat- 
nral  anatomical  occlusion,  we'll  first  finish  the 
upper  set;  and  then  take  the  lower  set    (which 


186  Greexe   Brothers'  Clinical  Course 

stays  down  from  musclestrimmed  non-resist- 
ance, weight,  tongue  power,  and  atmospheric 
pressure)  and  adjust  the  teeth,  in  the  mouth, 
to  the  finished  upper  ones  by  "each-mouthsits 
own=articuhitor-in5the-^«/.9"  action-to  be  shown 
a  few  minutes  later  on. 

If  we  can  control  the  one  seldom-thoughtsof, 
all^important  matter  of  strain  in  the  lateral, 
sheep=bite  action,  our  anatomical  occlusicni  will 
be  mighty  close  to  perfection.  And  t:his  is  what 
we  propose  to  do. 

CLASS  REQUESTS  DIFFICULT  AND   "CRIPPLE"=CASE 

ARTICULATION    AGAIN    AND    FURTHER 

EXPLAINED. 

^Vell,  to  review:  In  cases  of  pronounced 
deviation  from  the  normal  (as  in  extreme  pro- 
trusion or  retrusion,  where  even  the  '"average" 
is  evidently  out  of  the  question:  where  the 
three-and=a=half=inch  measuring^stick  wouldn't 
make  good,  nor  the  condyle  socket  be  tindable, 
for  face=bow  application )  — we  can  resort  to  our 
already  mentioned  process  of  real,  natural  auto- 
matical articulation:  that  is,  to  make  the  mouth 
itself  its  own  articulator  in  the  end. 

AVe  can  take  our  regular  non=moving  no^ 
bite  on  a  modeling=compound  bite^plate :  which 
would  give  at  least  a  close  approximation  to 
the  true  bite;  probably  a  correct  one. 

We  'd  then  soapstone  the  occluding  edges 
of  the  rim  to  prevent  adhesion,  and  warm  the 
lozcer  one  slightly,  so  as  to  mash  to  the  upper 
one,  not  warmed:  or  to  the  upper  teeth,  if  there, 
natural  or  artificial. 

Then  we  would  quickly  put  the  bite-plates 
into  the  mouth  and  have  patient  actually  chew 
on   them    in   all   directions.      This    would   mash 


IN   Dental   Prosthesis.  187 

the  soft  lower  rim  off  fairly  close  to  the  way 
the  teeth  should  be  set  up. 

Xext  we  would  place  the  bite,  as  a  whole, 
ill  the  articulator  in  a  way  to  see  it  make  as 
nearly  as  possible  the  same  movements  the  jaw 
made  in  masliing  off  the  lower  bite=rim. 

Future  generations  may  discover  some  way 
to  breathe  the  })reath  of  life  into  metal  jaws;  but 
even  then  they'll  have  to  also  discover  some  way 
to  graft  bite=plates  onto  them,  that  their  maneu- 
vers may  "make  good." 

In  some  cases  I  'd  face  my  lower  bitesrim 
with  soft-stone  (plaster  one  to  pumice=stone 
three)   for  easier  abrasion.      (Index  S.) 

If  patient  had  natural  teeth  above,  we  would 
use  a  model  of  them;  if  artificial  ones,  either 
a  model  of  them  or  the  denture  itself,  in  the 
articulator. 

In  this  kind  of  work  it  is  best  to  use  mod- 
eling c()mi)()siti()n  in  liolding  the  models  in  the 
articulator,  so  that,  if  necessary,  it  may  be  soft- 
ened in  the  slow  adjustment,  sometimes  inev- 
itable in  ariculathig  bites. 

We  'd  then  set  our  upper  teeth  to  the  lower 
bite=rims,  to  its  (inatomicaUy  mashcchoif  or  rcoru- 
uf  .surface,  carefully.  Then  set  up  the  lotcer 
to  the  upper  ones,  as  wanted,  anatomically, 
of  course.  The  teeth,  set  up  in  this  way,  must 
have  very  close  approximation  to  their  needed 
positions. 

We  would  then  wax  up  our  case,  not  for- 
getting our  tongue^rest  arrangements:  and  cool 
both  ])lates  while  yet  on  the  articulator.  Tlien 
take  them  off  tlie  articulator  and  warm  the 
lower  teeth  sliglitly  over  a  hand  -  spirit '  lamp 
fiame,  just  enough  to  render  them  movable  un- 
der some  pressure,  in  tlieir  waxed  environment. 


188  Greene  Brothers'  Clinical  Course 

Then  quickly  put  the  plates  into  the  mouth 
and  have  patient  go  through  all  the  chewing 
movements,  actually  on  the  teeth  themselves,  for 
adjustment.     This  is  the  "finis/' 

Barring  the  stress  feature  (always  contain- 
ing an  element  of  guess=work  without  the  press- 
ometer) ,  this  will  give  a  practical  "automatic" 
articulation;  especially  if  the  upper  set  is  fin- 
ished before  the  chewing  adjustment  is  made. 

It  is  very  particular  work  to  use  the  press- 
ometer  on  the  waxed-up  teeth.  For  then  the 
reduction  for  the  over=strain  must  be  made  by 
warming  them  and  pressing  down  on  them  to 
exactness,  tchile  tcann,  in  their  wax  investment; 
instead  of  cutting  or  filing  off  the  compound, 
as  shown  in  demonstrating  our  pressometer. 

In  taking  a  bite  for  an  auto=articulation  like 
this  (if  in  absence  of  the  pressometer),  it  is 
best  to  soften  the  bite  I'im  well  and  bite  lightly, 
if  over  soft  tissues,  to  avoid  getting  the  teeth  too 
long,  in  the  first  place. 

There  are  many  little  varying  details,  es- 
pecially in  these  unusual  cases,  that  you  will 
have  to  work  out  and  apply  yourselves.  But 
the  sum^total  of  the  operation  is  to  make  each 
individual  mouth  in  difficult  cases  to  be  prac- 
tically its  own  articulator.  And,  to  do  this, 
you  '11  have  to  take  some  pains  to  train  your 
patrons  how  to  do  their  part;  and  have  due 
patience  with  their  awkwardness.  You  have 
gained  the  victory  when  you  can  do  this. 

While  some  of  this  fine=point  work  would 
be  superfluous  in  plain,  easy  cases,  it  's  never- 
theless mighty  handy  to  resort  to  "every-mouth* 
its-own-articulator"  in  unusual  ones. 

But  for  Old  Green's  sake,  now,  don't  get 
this  mixed  up  with  the  common  old  "try'it* 
insthe*mouth"   uncertainty,   where   light,   guess* 


IN  Dental  Prosthesis.  189 

triiimied  lower  bitc'plates  jump  up  and  around 
like  mice  in  a  training-school,  preparing  for  a 
2)us.sy  s  cat  invasion.  Bite=plates  and  set  =  up 
teeth  must  stay  in  place^  to  make  good  in  the 
jinis. 

When  understood,  there  's  little  kind^ship  be- 
tween the  two  last^resorts. 

(X.  B.  — This  is  all  shown  in  detail,  on  the 
articulator,  in  the  verbal  Course.) 

NEW  WAY  TO  TAKE  TEST  NO=BITES,  IN  NO=HANDLE 
BITE=TRAYS. 

It  has  taken  me  many  years  to  invent  and 
put  into  2)ractice  what  I'm  now  going  to  show 
you.  It  is  a  combination  impressionsand^bite 
tray,  with  short,  movable  handles. 

With  the  handles  on,  I  take  my  impressions 
in  modeling  compound,  to  the  finish  test,  just 
as  shown  in  my  first  lecture. 

After  the  test,  I  cool  them  thoroughly  in 
tlie  moutli;  then  remove  them  therefrom  and 
cool  again,  and  also  remove  the  handles.  Then 
add  a  modeling=compound  bite=rim  onto  the 
metal  tray,  on  reverse  side  from  impression. 

The  test  impressions  are  now  also  bite=plates. 
We  '11  put  the  upper  one  in  and  out,  as  such, 
and  trim  it;  first  as  to  the  fullness  we  want  the 
lips  and  cheeks  to  show,  as  you  've  been  shown. 
And  then  trim  as  to  the  show=length  of  the 
teeth,  as  you  've  also  been  shown. 

Then  we  '11  take  the  lower  case  and  trim  it; 
but  this  time  first  as  to  the  slioxi' '  length  of  the 
teeth,  as  you  've  been  shown.  Then,  to  trim 
it  off  even  with  the  upper  rim,  we  '11  take  our 
first  tired^rest  bite,  to  serihe  it  for  that  purpose. 
Then  trim  it  off  to  the  scratch:  and  go  on  and 
finish  it  all  as  a  no-bite,  same  as  you  have  been 
shown. 


190  Greene  Brothers'  Clinical  Course 

Now,  we  '11  fill  our  impressions,  or  bite^plates, 
whichev^er  we  may  call  them  (separately).  And 
when  the  models  are  hard,  we  '11  j^lace  the  no= 
bite,  guided  by  the  jibing  notches  and  knuck- 
les, in  the  articulator.  And  from  this  on  we  '11 
finish  the  case  just  as  has  already  been  demon- 
strated. 

The  advantages  in  this  newest  invention  are: 
that  we  can  remove  tlie  handles  from  our  trays, 
to  better  get  the  fullness  of  the  lip  and  cheek, 
in  our  test  impressions;  also  that  there  is  no 
chance  for  slipping  and  changes  in  articulating 
the  bite,  nor  in  transferring  it  from  and  to  the 
models.  Also  bite=plates  can  not  warp  in  a 
metal  tray,  should  they  get  w^arm. 

Then,  we  save  the  time  of  waiting  to  make 
models  and  the  taking  of  impressions  of  them 
for  bitc'plate  purposes. 

In  this  bite'tray  method  we  can  still  use 
the  Greene  ready-made  metal  models,  in  filling 
our  impressions,  the  same  as  before,  if  we  want 
to.  And,  for  certainty  in  results,  that  always 
pays. 

IMPROVEMENT  IN  "BISCUIT"  BITES. 

Before  we  invest  our  case,  from  the  artic- 
ulator, I  '11  now  fulfill  my  promised  im})rove- 
ment  in  "biscuit"  bites,  to  be  used  should  you 
M^ant  to  go  back  to  the  old  habit  for  "old  hab- 
it's" sake. 

Take  your  "mush=bite"  in  the  usual  way, 
but  in  modeling  compound,  using  your  wood 
guide^stick  for    (approximate)    width  of  bite. 

Xine  chances  to  one,  you  've  taken  it  (the 
impression),  or  some  part  of  it,  at  too  strong 
pressure.  Xow  to  approximately  correct  this, 
just  pour  some  thin,  creamy =like  plaster  in  the 
upper  part,   shake   it   mostly  out,   and   take  it 


IX   Dental   Prosthesis.  191 

again,  just  as  before,  but  liglitly:  this  to  re- 
lieve excessive  strain,  if  any. 

Xow  add  to,  or  take  from,  and  trim  for  the 
feature=test.  with  lips  closed.  Then  take  the  lip= 
Ihie  (laugh=line)  and  mark  for  the  showslength. 
of  the  teeth,  all  around,  not  forgetting  the  short 
last  molars  above — 'for  reasons  explained. 

Then  with  a  frame-saw  cut  the  "biscuit" 
in  two  at  this  line;  and  go  on  and  take  the 
tired^rest  bite,  or  no^bite,  with  which  you  are 
familiar,  the  best  you  can.  under  the  unfavorable 
conditions. 

This  will  by  no  means  give  you  perfection, 
but,  if  the  im])rovements  liave  been  added  right- 
ly, there  will  be  far  less  guess-woi'k  in  your  l>ite 
and  its  results. 

FLASKING  THE  CASE. 

You  are  all  familiar  with  the  seemingly  sim- 
ple matter  of  flasking  the  case:  but  there  are 
some  usually  neglected  pohits  that  I  would  "hol- 
ler" in  tlie  ears  of  men  and  whisper  in  the  ears 
of  lady  dentists — for  best  attention. 

First  of  these  is:  See  that  the  metal  rims 
of  your  flask  come  together  without  rocking 
the  least  l)it:  and  see  that  it  's  no  bit  of  old 
])laster  that  prevents  their  rocking:  for.  if  so, 
it  may  disintegrate  and  come  away. 

Second:  See  that  your  models,  if  plaster, 
are  trimmed  down  to  not  over  a  quarter  of  an 
inch  in  thickness:  and  then,  to  raise  them  u]) 
to  needed  elevation  in  the  flask,  use  under  them 
some  non=changeable  filling  of  metal  or  its  etjuiv- 
alent.  T  keep  a  few  flat  metal  supports,  vary- 
ing in  thickness  from  one'quarter  to  three- 
quarters  of  an  inch,  and  set  them  witli  tliin  ])las- 
ter  on  one  another,  if  more  than  one  is  needed. 


192  Greene  Brothers'  Clinical  Course 

Do  this  even  with  metal  models  where  the}'^ 
need  elevating.  For,  though  the  disintegrating 
and  mashing  of  plaster  under  a  metal  model 
will  not  affect  the  fit  of  the  plate,  it  will  affect 
the  articulation.  Then  we  mis  -  attribute  the 
mal*come=together  as  a  ''wrong  bite." 

And  here,  doctors,  let  me  impressively  sug- 
gest that  if  you  can  at  all  spare  the  time  it  will 
always  pay,  especially  in  soft  mouths,  to  stop  here 
and  vulcanize  and  finish  your  upper  set;  and  then 
re-occlude  the  waxed-up  lower  case  to  it,  anatom- 
ically, in  the  mouth  before  flasking  it. 

But  to  our  flasking:  Use  only  good  plaster, 
mix  as  carefully  as  in  making  a  model,  to  avoid 
disintegration;  then  wait  for  perfect  hardening. 

PACKING  AND  VULCANIZING. 

To  open  the  flask,  warm  it  over  a  small 
spirit  flame,  and  only  enough  to  provide  against 
breaking  the  model.  When  it  is  warmed  through 
from  the  under  side  till  its  top  is  of  good  flesh 
temperature,  it  is  about  right.  Then  the  wax 
inside  isn't  melted  fast  to  the  plaster. 

Open  first  at  the  opposite  point  from  any 
under^cut  in  the  model;  that  is,  usually,  prize 
first  at  the  heel.  When  apart,  quickly  pull  out 
all  tlie  wax  that  will  come  away.  Then  dip 
in  cold  water  a  minute,  when  you  can  easily 
and  cleanly  flip  off  the  thin  flakes  of  sticky= 
wax,  loosely  adliering  to  the  teeth  and  plaster. 

It  is  better  to  get  it  out  in  this  cold  way 
than  to  steam  it  or  boil  it  out;  as  no  wax 
then  soaks  into  the  plaster,  or  sticks  to  the 
teeth,  to  interfere  with  proper  vulcanization. 
Bear  in  mind  that  it  may  be  even  invisible 
wax.  left  on  the  teeth,  that  causes  softness  and 
difliculty  in  finishing  the  pink  rubber  about 
their  necks. 


IX   Dextal   Prosthesis.  193 

Use  none  but  the  very  best  vulcanite. 

Dentists  save  money  at  costly  risk  of  their 
reputation  in  using  poor  materials.  They 
"fake,"  maybe  unwittingly,  on  a  mighty  small 
financial  scale,  in  using  poor  grades  of  rubber — 
in  fact,  poor  grades  of  any  other  material — in 
dental  work. 

Pack  carefully;  use  dry  heat;  squeeze  light- 
ly, and  close  very  slowly.  And,  no  matter  how 
experienced  you  may  be  in  guessing,  you  'd 
better  use  the  trial  cloth,  especially  in  lower 
cases.  Use  pink  rubber  in  the  center  of  thick 
upper  rims  and  weighted  rubber  in  thick  lower 
ones  to  prevent  jjorosity,  excepting  in  front. 

The  trial  cloth  is  that  which  comes  between 
sheets  of  rubber.  Don't  wash  the  starch  quite 
all  out.  Then  kee])  it  wet.  lest  it  may  stick  to 
the  hot,  soft  vulcanite. 

HOW  TO  VULCANIZE. 

Only  a  few  points  here;  and  still  fewer  of 
them  new.  But  you  are  a  rare  flock  of  ])ros- 
thetic  birds  if  some  of  you  don't  need  to  have 
some,  even  of  the  old  ones,  re^suggested  to  you. 
"He  that  hath  ears,  let  him  hear" — it  again. 

Then  vulcanize  at  the  lowest  point  possible 
Avith  your  tried-  and  known  thermometer  and 
vulcanizer.  Xot  all  thermometers  register  tem- 
perature alike.  Xor,  indeed,  do  all  vulcanizers 
Avork  alike.  I  have  carefully  changed  the  same 
thermometer  to  different  vulcanizers  and  found 
pronouncedly  different  results. 

Then  test  your  vulcanizer  often  enough  to 
"know  for  yourselves,  and  not  for  another," 
just  how  it  works.  Then,  in  practical  use,  run 
it  at  the  lowest  vulcanizing  temperature  and 
long  enough  to  a  tougli^liardness,  and  not  a 
brittle  one. 


[13] 


194  Greexe   Brothers'  Clinical  Course 

Then  leave  it  in  the  flask,  but  not  neces- 
sarily in  the  vulcanizer,  for  several  hours.  Yes, 
for  several  hours,  even  after  it  has  cooled.  Leave 
it  in  the  flask  over  night  if  you  can.  And  don't 
accept  this  advice  as  a  whimsical  notion  of  an 
old  =  timer  without  reason.  Each  package  cf 
vulcanite  sent  out  to  the  dentists  at  its  first 
introduction  contained  this  advice  and  warning. 

I  '11  not  attempt  to  give  you  the  chemical 
reasons,  but  the  practical  fact  is  that  rubber, 
it  seems,  doesn't  complete  its  crystallic  or  other 
hardening  arrangement  during  the  cooling  pro- 
cess: and,  if  taken  out  of  its  imbedment  too  soon, 
it  is  liable  to  warp.  Then  the  consequences 
(which  may  come  even  after  worn  awliile)  are 
often  attributed  to  '"change  of  the  mouth."  ElV- 
perimcnts  in  my  oicn  mouth  prove  this. 

And  this  is  particularly  true  where  scraping 
and  tiling  are  done  to  the  extent  of  bringing 
a  ^^■eake^  grain  texture  to  the  surface.  So,  let 
your  ]jlates  '"season"  several  hours,  when  you 
can.  ]Make  quick  plates  only  in  cases  of  need- 
ful hurry. 

I  wish  I  had  a  Gabriel's  horn  to  toot  to  tlie 
prosthetic  dental  world  not  to  boil  their  cases 
and  soften  their  plaster  models  before  squeezing 
too-ether:  and  then  not  to  use  much  force,  anv- 
how.  Xinetv  per  cent  of  vou  need  this  strong- 
talk. 

DISHONESTY   IN   RUBBER   PLATES. 

I  know  mainly  three  reasons  for  brittle 
rubber  plates:  (a)  absolute  Dishonesty;  {b) 
Carelessness,  which  is  a  reckless  child  of  Dis- 
honesty: and  (c)  Ignorance,  vdiich  is  a  legit- 
in^.ate  offspring  of  Carelessness. 


IX   Dextal   Prosthesis.  195 

When  a  vulcanite  plate  breaks,  especially 
if  in  the  mouth,  the  dentist  ought  to  be  re- 
sponsible for  it.  For  it  is  next  to  impossible 
to  break  a  pro2)erly  made  plate  of  really  good 
stuff;  and  it  is  a  dentist's  duty  to  test  his  ma- 
terial before  promiscuously  using  and  selling  it. 

It  Mould  pay  you  all,  and  at  the  same  time 
be  a  good  "educator  of  the  people."  to  make 
and  keep  several  toothless  plates  to  jmnp  up= 
and=down  on,  and  to  throw  against  the  wall,  to 
show  your  patients  zchat  you  can  do;  and  then 
do  it  lionestly.  I  insist  that  a  pro])erly  made 
and  properly  titled  vulcanite  plate,  of  good  ma- 
terial, zcill  not  brcaJc  in  the  mouth;  nor  will  it 
out  of  the  mouth  without  considerable  effort. 
The  '"cowshorn""  samples  sent  out  by  the  man- 
ufacturers are  proof  of  that. 

There  are  numerous  coverings  for  plaster 
models,  to  prevent  the  usual  deterioration  of 
rubber  in  vulcanizing  contact  with  gypsum. 
There  are  some  excellent  liquid  "glosses."  Af- 
ter strongly  advising  those  of  you  who  dont 
use  anything,  to  use  soincthins!;,  I  will  state  that 
1  still  use  thin  tin^foil.  preferably  number  four. 
And  even  thni  gold  foil  is  not  too  expensive 
for  the  benefit,  if  no  tin  is  at  hand.  The  claim 
that  thin  foil,  placed  evenly  all  over  a  model, 
will  change  the  fit  of  a  plate,  on  flesh  tissue, 
is  high=grade  theori/.  backed  by  low-grade  faet. 

The  model  is  at  first  })ainted  with  very  thin 
varnisli,  and  the  foil  then  hurriedly  smoothed  on 
with  a  connnon  shaving=brush.  Then  the  foil 
is  as  liurriedly  smoothed  over  with  pulverized 
soajjstone  on  the  brush.  ( We  licked  the  foil 
on  before  the  days  of  dangerous  microbes.) 

If  for  no  otlier  one  of  several  good  reasons. 
I  would  thus  cover  my  i)laster  models  to  bring 
them  out   of  the   flask  clean   and   save  time   in 


196  Greene   Brothers'  Clinical  Course 

not  otherwise  even  half' way  cleaning  them  of 
tightly  adhering  plaster. 

Plaster  can  he  very  quickly  scruhhed  off  the 
foil,  and  the  foil  as  quickly  eaten  off  the  plas- 
ter, by  a  thin,  hasty  amalgam,  made  in  the 
hand,  of  tin^foil,  or  tobacco^foil,  and  mercury. 

The  fact  is,  a  rubber  plate  should  come  out 
of  the  flask  clean,  fairly  smooth,  and  almost 
finished.  It  should  need  no  trimming,  other 
than  of  small  excess  extensions;  no  filing,  nor 
scraping,  as  to  its  shaping.    And  no  grinding. 

LAST  FINISHING  CARE  IN  ARTICULATION. 

Ten  to  t^venty  minutes  will  finish  our  double 
set  of  teeth,  after  out  of  the  flask,  if  we  have 
modern  lathe  machinery.  We  '11  slip  them  into 
patient's  mouth  to  see  whether  or  not  they 
come  together  properly. 

Xor  will  we  jump  to  any  hasty  conclusion 
about  it;  for  we  have  all  been  fooled  in  that 
way.  We  have  quickly  concluded  articulations 
w^ere  all  right,  when  a  few  hours,  or  days,  ]:)roved 
otherwise.  And  sometimes  we  have  hastily  said 
to  ourselves,  if  not  to  our  patients:  ''They  are 
all  wrong;  you  hit  wrongl}",  and  I  11  have  to 
make  them  over;"  when  a  little  time  showed 
a  mistake,  in  our  favor. 

Xow,  to  forestall  the  like  of  this,  we  '11  take 
a  regular  no^bite  on  the  finished  denture  to  see 
for  sure  about  it.  If  it  proves,  all  is  well.  If 
the  teeth  don't  hit  rightly,  after  all  these  precau- 
tions, it  is  ninestO'One  on  account  of  some  change 
after  in  the  flask,  during  vulcanization. 

But  it  can't  be  much  wrong;  nothing  that 
can't  be  corrected.  So,  if  needs  be.  we  '11  cor- 
rect it.     And  here  is  the  way  we  '11  do  it. 

We  '11  trace  a  little  very  thin  smidgen  of 
plaster  on  top  of  the  lower  teeth  and  take  an- 


IN  Dental  Prosthesis.  197 

other  no'bite  on  it.  Wlieii  the  plaster  is  hard, 
we  '11  take  the  teeth  out  of  the  mouth,  and, 
using  compound  or  bees* wax  instead  of  plaster, 
we  '11  fasten  them  in  the  articulator;  the  plaster 
on  the  teeth  being  our  articulating  guide. 

In  placing  them  in  the  articulator,  we  '11  be 
just  as  careful  in  the  use  of  the  face-bow,  or 
measuring'Stick,  as  we  were  in  articulating  the 
bite  in  the  first  place,  and  for  the  same  ex- 
plained reasons.  (We  '11  now  go  to  the  labora- 
tory, out  of  patient's  sight.) 

When  these  finished  dentures  are  in  the  ar- 
ticulator, we  '11  remove  the  plaster  from  be- 
tween them,  bring  them  together,  and  look  un- 
der and  see  what  has  to  be  ground  off. 

A  few  touches  with  tlie  carborundum  wheel, 
and  the  worst  is  off.  Xow  we  '11  follow  up 
with  carborundum  sand^paper,  by  sliding  it  be- 
tween the  teeth  until  eacli  one  will  touch  its 
opponent,  even  to  the  holding  of  the  thinnest 
tissue  paper,  if  we  so  wish. 

But  in  this  final  grinding  we  mustn't  neg- 
lect to  give  the  lateral  motion  to  the  articu- 
lator, to  wear  the  teeth  off  to  the  regulation 
lateral  quid=chewing  attrition. 

A  STILL  FINER  LAST  GRINDING  TOUCH. 

A  still  finer  last  toucli  may  be  made  with 
carborundiun  grit.  Stick  a  strong  piano'wire 
coil-spring  firmly  onto  the  extending  point  of 
the  guide  screw  of  the  articulator,  of  a  length 
to  ])ush  the  teeth  to  about  an  inch  apart. 

Then  put  ^a  "bumpswheel"  on  your  lathe 
s])indle  and  hold  the  articulator  so  the  bumps 
will  strike  it  on  to]).  The  spring  will  open  the 
jaws,  and  the  bump  (one  or  more)  on  the  wheel 
will  close  them.  Thus  you  '11  have  a  chewing^ 
machine  to — chew  too  fast,  if  vou  don't  watch  out. 


198  Greene  Brothers'  Clinical  Course 

TIlis  wheel  maj^  be  of  felt,  soft  wood,  doub- 
led sole-leather,  or  soft  rubber;  and  should  be 
from  four  to  five  inches  in  diameter.  One  bump 
is  enough. 

All  you  need  to  do,  to  add  this  last  exquis- 
ite touch,  is  to  feed  a  mixture  of  carborundum 
grit  and  glycerine,  with  a  small  brush,  while 
you  wabble  the  jaws  for  the  quid  '  motion — ^^and 
whistle  "Yankee'DoodlesDixie"  ten  or  fifteen 
minutes.  Some  dentist,  ^vithout  reflecting  what 
nerve  mixture  the  average  man  or  woman  is 
made  of,  has  notoriously  suggested  that  this 
grit  -  grinding  process  should  be  done  in  the 
mouth ! ! !    "The  Great  G.  Whiz !  Who  is  he ?" 

BETTER  DEFER  FINAL  ADJUSTMENT. 

But,  doctors,  it  is  best  in  cases  of  unequal 
tissues  and  soft  mouths  to  let  artificial  dentures 
be  worn  a  few  hours,  or  in  bad  cases  days,  for 
adjustment,  before  those  final  touches  in  oc- 
clusion are  given.  It  's  best,  really,  to  let  all 
artificial  dentures  "settle"  well  before  the  final 
occlusive  grinding — if  they  need  grinding. 

INSTRUCTIONS  TO  WEARER  OF 
ARTIFICIAL  TEETH. 

"Now,  JNIadam,  you  ha\T  a  set  of  teeth  that 
stand  the  best  regulation  test.  The  upper  ones 
stay  in  your  mouth  witli  usual  movements  of 
face  and  deglutitory  muscles. 

"The  lower  ones  stay  in  place  with  these 
ordinary  movements,  and  you  can  hold  them 
in  their  extraordinary  motion. 

"The  dentist  has  done  his  part  faithfvdly  to 
the  finish.  Will  you  do  yours  the  same?  If 
so,  all  will  be  well,  and  you  '11  have  comfort 
and  benefit  that  can't  be  measured  by  money. 


IN   Dental   Prosthesis.  199 

'But  it  maij  require  some  auto=suggestive 
determination,  perseverance,  and  practice  to 
reach  the  goal. 

^  First:  Use  your  own  favorable  auto-sug- 
gestion, and  reject  the  adverse  suggestions  of 
others.  This  is  the  first  and  generally  the  worst 
thing  wearers  of  new  teeth  have  to  meet  ^\itli 
and  to  overcome. 

"Some  may  tell  you  your  teeth  are  too 
short,  and  others  tell  you  too  long.  Some  ma}' 
sa\^  they  fill  your  mouth  out  too  much,  and 
others  saj^  not  enough.  Many  will  insist  that 
your  teeth  are  too  dark,  and  some  few  say  too 
white;  and  so  on. 

"^Vithout  their  pre  '  auto  '  suggestion,  few 
women,  or  men,  under  similar  circumstances, 
wouldn't  be  disconcerted  as  to  their  hats  or 
coats. 

"And  hardly  one  woman  in  one  hundred 
who  could  not  be  discomposed,  and  run  in  off 
the  street,  if  strangers  were  to  look  at  her.  and 
several  of  her  friends  should  tell  lier  that  her 
skirt  was  ridiculously  short;  even  in  face  of 
the  truth  that  it  was  too  long.  Indeed,  any 
discussion  about  the  matter  would  disconcert 
her.     Of  course,  you  are  an  exception!! 

"Now,  Madam,  your  teeth  are  right  in  size, 
style,  and  color  to  suit  your  features;  your  oxi.'n 
features. 

"I  have  made  them  to  look  like  your  per- 
feet  natural  teeth  would  look  at  your  peaceful 
stains  of  earthly  incarnation,  sometimes  vulgarly 
stated  as  your  age.  Beware  especially  of  what 
your  inartistic  friends  may  say  as  to  their  sliade. 

"If  they  were  lighter  in  color,  the  contrast 
would  make  you  appear  ridiculous,  and,  in  fact, 
the  older.  They  give  you  the  appearance  of 
a  })reserved  lady  of  your  sweet  sixty.  So,  ac- 
cept no  suggestion  to  the  contrary! 


200  Greene  Brothers'  Clinical  Course 

"Aiid,  now,  for  learning  the  art  of  che wing- 
on  them.  This  conies  much  more  naturally  to 
some  people  than  to  others.  But  all  have  it  to 
learn;  and  most  of  them  by  progressive  degrees. 

"You  '11  first  have  to  learn  to  chew  on  both 
sides  of  your  mouth  at  the  same  time.  This  is 
to  cause  your  gums  to  settle  and  adjust  them- 
selves to  both  side  alike.  Otherwise  the  plates 
Avould  settle  the  more  unevenly  as  the  usual 
adjustment  took  place. 

"You  will  easiest  and  quickest  learn  on  thin 
slices  of  boiled  ham  or  tender  dried  beef.  Put 
a  piece  on  either  side  to  place  and  clietc,  and 
chew,  and  chew,  and  swallow  and  chew. 

"Go  on  and  'Fletcherize'  till  meal=time,  and 
then  take  the  plates  out  of  the  mouth.  But, 
when  the  meal  is  over,  go  at  it  again  and  chew 
sliced  meat  or  its  equivalent  as  before,  on  both 
sides  at  once,  until  meal^time  again;  and  so 
forth. 

"Keep  this  up  persistently  till  you  can  chew 
a  little  better  icith  the  teeth  than  mthout  them. 
This  will  not  be  many  days.  Then,  when  you 
feel  their  need  and  benefit,  leave  them  in  dur- 
ing meals.  But  then,  at  first,  use  only  small 
bits,  if  of  promiscuous  food. 

"In  a  week  or  ten  days,  you  '11  begin  to  use 
them  pretty  well;  and  in  a  mouth,  or  less, 
perfectly. 

"Heed  this  advice,  and  you  '11  have  no 
trouble;  ignore  it,  and  your  road  to  success 
may  be  longer,  if  not  beset  with  difficulties, 
both  imaginary  and  real. 

"And  now,  further,  Madam,  to  forestall  all 
ill  suggestion,  auto  or  otherwise,  I  '11  here  and 
now  clinch  and  settle  the  matter  of  mastica- 
tion. I  have  here  some  of  the  thin  slices  of 
ham  and  beef  I  've  advised,  and  will  give  you 


IX   Dental   Prosthesis.  201 

a  practical  start  that  will  be  unquestioned  and 
satisfactoiy.  [Here  she  is  made  to  chew  on 
both  sides  at  a  time  until  she  is  satisfied.] 

"Now,  Mrs.  Jones,  you  have  chew^ed  several 
minutes  without  trouble.  Xext  time  it  will  be 
easier;  and  the  next  time  still  easier;  and  so 
on  until  you  '11  forget  that  your  teeth  are  shops 
made,  at  all. 

"Your  teeth,  at  first  seemingly  naughty  and 
worrying,  will  in  time  behave  admirably  from 
your  persistent,  but  serene,  will-power. 

"Your  eyes  will  renew  their  suasive  dancing. 
Your  cheeks  and  features  will  regain  their  full- 
ness and  flush  of  the  sweet  ago — ^^as  much  as 
the  Goddess  of  Duration  thinks  best  for  you. 

"And  even  your  inartistic  friends  will  ad- 
just themselves  to  your  regenerated  looks  and 
feelings  of  sweetness. 

"But,  finally,  ]Madam,  I  beg  and  implore 
you  not  to  accept  tliis  extra  fine,  artistic  set 
of  teeth  merely  on  financial  account.  In  such 
a  case,  money  is  vulgar.  I  've  taken  all  these 
pains  for  your  happiness  and  my  own  glory/' 

NO=BlTE  OF  A  PLAIN  UPPER  CASE. 

iBeing  through  with  a  plain  full  "double" 
set,  we  '11  now  take  up  this  single,  simple,  up- 
per, toothless  jaw,  articidating  with  a  toothful 
loM'cr  one.  If,  however,  a  few  lower  teeth  were 
lacking,  the  bite  would  be  similar. 

We  manage  a  similar  case  one  way,  and 
a  good  way,  in  our  "advertiser's  quick-step." 
(Index  A.)  And  another  in  the  Greene  quick- 
step. (Index  G.)  Xow  we'll  have  two  more 
ways;  the  first  one  being  my  own  once  "regu- 
lar" way. 

T  have  it  here  on  this  same  old* fashioned 
articulator   with   anatomical   attachments.      But 


202  Greene   Brothers'  Clinical  Course 

the  same  princi])les  and  points  will  apply  on 
any  other  articnlator. 

Take  yonr  model,  on  which  you  intend  to 
^  ulcanize  your  plate,  and  soapstone  it  to  pre- 
\'ent  the  impression  material  from  sticking  to 
it.  Then  take  an  impression  of  it,  without  a 
tray.  Work  the  impression  down  thin  in  the 
roof,  and  build  it  out  full  enough  and  down 
long  enough  to  allow  for  trimming,  both  as  to 
the  fullness  of  lips  and  the  show^length  of  the 
teetli.  It  is  always  easier  to  trim  off  than  to 
add  to;  even  by  our  new  w^ay  of  tracing'on 
modeling  compound  from  our  "blessed"  tracing- 
sticks. 

The  projecting  shoulder  on  the  model  will 
l)e  your  guide  as  to  the  thickness  of  the  bite^ 
plate's  rim  at  the  top.  Xext  trim  for  the  ap- 
proximate fullness  of  the  outer  lip  lower  down. 
But  exactness  here  isn't  really  of  much  im- 
portance, since  the  upper  teeth  have  to  come 
together  within  certain  relations  to  the  natural 
lower  ones  below,  anyhow. 

Then  next  comes  the  show*length  of  the 
teeth,  where  no  guess  ^work  is  permissible. 
]Mark  the  lip=line,  harmonizing  AA'ith  the  laugh* 
line,  and  trim  the  bite=]3late  down  to  it.  Cut 
in  front  only,  and  for  the  width'Space  of,  say, 
the  four  incisors;  and,  if  needs  be,  including 
cuspids.  Then  have  patient  repeat  vigorous 
smiling  until  you  're  sure  of  the  proper  show* 
length  of  the  coming  teeth. 

If  you  can't  see  well,  you  can  paste  a  strip 
of  white  paper  onto  the  bite*rim,  down  to  where 
you  have  trimmed  it,  to  show  how  long  the  teeth 
would  show;  or  you  could  even  stick  some  in- 
cisors onto  the  compound,  if  you  wanted  to. 

Next:  Cool  the  trimmed  portion  in  front 
and  warm  the  top  of  all  the  rest  of  it,  rearward. 


IN   Dental   Prosthesis.  203 

Then  have  her  bite  onto  this  softened  top  until 
the  trimmed,  hard  front  strikes  the  lower  teeth 
and  stops  the  jaw.  If  this  should  require  more 
tlian  once  warming,  repeat  it,  of  course. 

When  you  have  had  patient  mash  off  the 
bitc'rim  for  the  show^length  of  the  teeth,  and 
have  removed  the  sidc'inashed  surplus,  you  are 
ready  to  tire  her  jaw  and  register  its  natural 
position;  that  is,  to  take  the  no=bite,  which  is 
some  different  from  the  full  set,  in  this: 

Instead  of  testing  it  by  notches  and  knuck- 
les, as  we  did  in  the  full  case,  you  '11  do  it  in 
this  way:  Roughen  the  bite^rim  in  front,  back, 
say,  to  the  place  of  the  first  bicuspid,  so  that 
warm  compound  will  stick  to  it.  You  '11  have 
a  little  roll,  or  thin  slab,  of  this  in  hot  water 
ready  for  use.  And  now  for  the  non-lateral, 
perpendicular,  minimum  short  bite.  Is  it  nec- 
essary to  sliow  that  again:"  (Class:  ''Yes;  go 
on  and  give  it  again.") 

THE  NON=LATERAL,  MINIMUM  SHORT=BITE, 
OR  "NO=BITE,"  DESCRIBED  AGAIN. 

"Xow,  Madam,  suck  this  bite^phite  up  tight- 
ly; then  let  your  jaws  approach  very  slowly 
till  your  li^^s  touch  together  lightly  and  the 
lower  teeth  almost  touch  the  rim. 

"There,  there,  ^ladam!  hold  just  that  way 
while  I  coimt  ten;  then  snap  and  hold  fast. 
One,  two,  three,  four,  five,  six,  seven,  eight, 
nine,    ten — snaj)  and  hold!" 

The  jaw^  was  at  tired-rest,  and  the  remain- 
ing space  too  narrow  to  admit  of  unintentional, 
lateral  side-motion. 

While  she  bites  down,  I  take  my  strip  of 
ready  warmed  compound  and  press  it  firmly 
against  the  roughened  bite*rim  (above)  and  also 
against  the  natural  teeth,  below. 


204  Greexe   Brothers'  Clixical  Course 

The  rough  surface  on  the  bitesrmi  will  hold 
it  till  I  get  done;  and  the  saliva  on  the  lower 
teeth  will  prevent  its  sticking  thereto. 

I  Mill  now  take  it  out  of  the  mouth  and, 
Mitli  a  small,  hot  knife=blade,  stick  this  con- 
necting strip,  at  both  of  its  ends,  more  tightly 
to  the  roughened  rim,  lest  it  might  come  loose. 
The  two  together,  the  strip  and  the  bite* 
rim,  look  like  a  single  piece  into  wliich  she 
has  bitten.  But  the  biting  was  done  (at  short 
range,  avoiding  lateral  motion)  before  the  con- 
necting strip  was  pressed  on. 

Xext  we  "11  warm  our  knife=blade  again  and 
shorten  the  connecting  strip  off  down  almost 
even  with  the  edge  of  the  bite  -  rim  proper. 
We  '11  leave  just  enough  to  show  a  little  of 
the  sockets  of  the  lower  teeth,  into  which  these 
teeth  are  to  enter  when  we  make  our  no^bite 
test,  later  on. 

Well,  the  connecting  strip  has  now  been 
shaved  off,  and  on  purpose  that  we  can  see 
the  ends  of  the  lower  teeth  enter  the  shallow 
sockets:  or  else  fail  to  enter,  if  the  no^bite 
should  be  wrong,  when  we  make  the  test. 

So  we  are  now  ready  to  test  our  no=bite. 

THE   FULL   UPPER   NO=BITE   TEST. 

"Again,  ]Madam,  give  me  a  test=bite  on  this. 
Close  slowly  just  as  before;  only  this  time  keep 
your  lips  apart  so  I  can  see  your  teeth  enter 
their  little  sockets  as  you  close. 

"Close  slowly,  slowhj!  There,  now.  your 
teeth  almost  touch  the  rim.  Hold  till  I  count 
ten:  One,  two,  three,  four,  fire,  six,  seven,  eight, 
nine,  ten!" 

I  looked  up  under  her  lip  and  .sr/tc  the  ends 
of  her  lower  teeth  smoothly  slide  into  their  shal- 
low sockets  on  the  edge  of  the  upper  bite*rim. 


IN  Dextal  Prosthesis.  205 

"Xow,  ^ladam,  that  's  correct.  Let  me  try 
it  again." 

We  test  again;  and  the  fact  that  the  jaw 
ucas  at  rest  is  confirmed  by  three  or  more  tire= 
test  witnesses. 

If  the  teeth  had  missed  or  failed  to  go  into 
their  sockets  smoothly,  a  few  trials  would  have 
shown  at  which  one  of  the  three  times  the  jaw 
had  moved  sideways.  In  such  a  case,  the  nO' 
bite  would  simply  have  to  be  re^taken  until  the 
case  icould  prove.  But  the  proof  would  be  un- 
questionable. 

But  we  are  here  granting  a  very  remote 
probability;  for,  if  this  operation  is  rightly 
done,  it  will  not  fail  once  in  fifty  times.  Of 
course,  this  "rightly"  includes  receptive  in- 
structions and,  sometimes,  some  training  of 
patients. 

And  here  let  us  lament  that  dentists  gen- 
erally know  so  little  about  methodical  sugges- 
tion to  their  patients.  (A  fourth  lecture  will 
be  added  to  this  Course  on  "Scientific  Sug- 
GESTiox  IX  Dental  Practice/'  before  long.) 

TRANSFER  THE  NO=BITE  TO  ARTICULATOR. 

Xow  let  us  transfer  our  test-bite  onto  the 
articulator.  We  '11  use  a  model  of  the  natural 
lower  teeth:  preferably  a  metal  one.  Such  can 
be  made  of  low=fusing  metal,  in  a  modelings 
compound  impression,  as  readily  as  of  plaster. 
And  the  advantage  is  that  the  teeth  on  it  won't 
wear  by  careless  friction  like  on  a  ])laster  one. 

The  shallow  sockets,  aforesaid,  in  ovu*  upper 
bite^rim  will  be  our  guide  in  placing  the  bite 
onto  the  lower  model. 

If  we  have  no  face5bo^^^  or  don't  know  how 
to    use    one.    or    can't    find    the    exact    condvle 


206  Greexe  Brothers'  Clinical  Course 

movement,  we  '11  substitute  our  always  avail- 
able three=andsashalf=inch    measurement  *  stick. 

But  if  we  use  the  old  "plane^line"  articulator 
there  's  no  danger  of  getting  a  bite  too  far  back 
in  its  jaws. 

We  '11  then  first  place  the  lower  model  cor- 
rectly straight  in  the  articulator  on  the  table 
with  the  ends  of  the  teeth  at  least  approxi- 
mately three  and  a  half  inches  from  the  cross- 
bar, and  fasten  it  there.  Then  press  the  bite 
to  place  onto  this  lower  model  carefully;  then 
the  upper  model  into  this,  its  bite=plate.  Then 
bear  down  firmly  on  the  model,  without  press- 
ure on  the  metal  jaw,  while  we  plaster  it  all 
together. 

We  '11  next  change  off  our  bite^plate  for  a 
base=plate,  onto  which  the  teeth  will  set. 

This  basesplate,  as  shown  in  the  double*set 
case,  should  be  of  the  Kerr  "Perfection,"  and 
pressed  onto  the  model  as  I  have  before  shown. 

Of  course,  all  base^plates  must  be  secured 
onto  their  models  before  placed  into  the  articu- 
lator; and  absolutely  held  so  during  the  sticking 
of  teeth  there=on=to.  This  is  done  with  not  less 
than  three  little  patches  of  hot  modeling  com- 
pound of  ^4  ^^^^^  width. 

Next,  we  '11  set  the  teeth  to  the  lower  model 
always  w  ith  an  eye  on  the  set^screw.  AVe  '11  jirst 
give  tliem  a  square  "one=way"  come-together,  and 
then  follow  up  with  the  chewing  movements  of 
tlie  articvdator  lower  jaw. 

And  here  is  the  advantage  of  metal  models 
of  the  lower  teeth  over  ])laster  ones:  the  metal 
ones  won't  wear  off  by  the  adjusting,  frictional, 
chewing  process,  in  anatomical  adjustment. 


IN   Dental  Prosthesis.  207 

From  this  on,  the  work  is  the  same  as  sho^^'n 
in  the  upper  one  of  our  double  set. 

PINK  RUBBER  AND  GUM  SECTIONS. 

To  be  honest  with  my  patient,  I  \\ould  use 
pink  rubber,  if  at  all,  no  higher  up  than  the 
laugh=test  indicates. 

When  I  want  to  make  an  extra  nice  set  of 
teeth  on  vulcanite,  I  use  gum  sections  of  pat- 
tern and  shade  to  harmonize  with  my  patient's 
normal  face  and  her  age. 

I  think  harmony  may  be  of  even  first  im- 
portance, over  tlie  fit  of  artificial  teeth.  For 
a  plate  worn  in  a  hand-bag  won't  do  botJi,  dis- 
grace the  dentist  and  disfigure  his  patient. 

I  well  remember  when  it  was  unethical  and 
disgraceful  to  make  a  permanent  denture  of 
"plain  teeth."  In  fact,  gumless  teeth  have 
made  rubber  work  so  easy,  in  a  manner,  as  to 
bring  it  into  disrepute. 

BITES  IN  SCATTERING  CASES. 

On  my  rounds  among  dentists  I  find  quite 
a  good  many  still  taking  base^plate  rim^bites  in 
])artial  cases  of  scattering  teeth.  In  such  a 
case,  the  best  and  only  bite  needed  is  to  make 
models  of  the  natural  teeth,  upper  and  lower, 
and  i)lace  these  together  ])roperly  on  the  artic- 
ulator, and  exactly  as  those  touched  in  the 
mouth.  Abrasion  of  the  natural  teeth,  co])ied 
onto  tlie  models,  will  nearly  always  sliow  how 
to  match  the  models  in  the  articulator  without 
any  other  bite.  But,  in  exceptional  instances. 
thin  sheets  of  bite=marked  wax  will  hel))  in  the 
adjustment.  Indeed,  in  many  cases,  it  's  not 
necessary  to  even  put  them  in  the  articulator. 
Well,  indeed,  I  've  met  several  fairlv  successful 


208  Greene   Brothers'  Clinical  Course 

plate* workers  (from  the  old* way  view  poiiit)  who 
never  use  articulators  in  any  case. 

PRESSOMETER  IN  UPPER  CASES. 

In  single  upper  cases,  it  is  seldom  necessary 
to  use  the  pressometer;  only  when  decided  dif- 
ference in  texture  at  different  places  is  evident. 
You  have  been  shown  its  practical  use  under 
such  circumstances. 

But,  in  any  case,  the  teeth  on  the  wax  base= 
plate  should  touch  their  opponents  a  little  bit 
first  over  the  soft  parts,  to  make  up  for  un- 
equal settling.  The  exception  is  where  hard 
parts  support  adjacent  soft  ones. 

From  this  on  to  the  finish  of  our  single  up- 
per case,  we  '11  closely  follow  the  demonstra- 
tion, directions,  and  precautions  given  in  the 
upper  one  of  the  double  set.  We  '11  sacredly 
lieed  the  points  of  special  importance  in  ma- 
terial, flasking,  packing,  vulcanizing,  and  the 
countersign:  Keep  an  eye  on  the  set'sereic,  and 
don't  spring  the  articulator. 

PARTIAL  POSTERIOR  LOWER  BITE. 

Here  is  a  case  of  a  partial  lower  set,  where, 
for  instance,  the  molars,  and  maybe  biscupids, 
are  lacking;  but  the  front  teetli  are  intact.  It 
is  a  case;  wherein  even  truthful  dentists  will 
sometimes — ^prevaricate,  a  little.  At  least,  I 
think  so  when  they  tell  me  tliey  seldom  have 
to  grind  the  teeth  off  after  vulcanizing. 

Only  those  who  carefully  observe  and  get  the 
proper  strain  in  taking  their  bite,  or  in  trying 
the  teeth  in,  can  truthfully  avoid  making  the 
common  error  of  getting  the  jaw  teeth  too  long 
— if  the  tissues  under  the  plate  are  soft. 

And  it  comes  about  in  this  way:  They  take 
the  bite  too  hard;  that   is,  the  material  is  too 


IX  Dextal   Prosthesis.  209 

hard,  or  tlie  pressure  on  tlie  soft  tissues  too 
strong — maybe  both.  The  prineiple  is  iUustrated 
in  the  use  of  our  pressometer.      (Index  P.) 

A  short  way  of  stating-  the  fact  is  this:  The 
patient  bit  more  into  the  flesh  than  into  the  ma- 
terial. In  the  biting,  the  natural  teeth  didn't  give 
down  at  all.  If  the  soft  tissues  under  the  bite- 
plate  gave  ant/,  then  the  finished  teeth,  when  set 
up  to  tlie  bite,  will,  of  course,  come  together 
just  as  much  too  soon  as  was  the  difference  in 
the  yielding. 

xVlso.  at  the  natural  wearing  stress  of  a  dent- 
ure, of  course  such  gums  yield  some.  Now, 
whatever  amount  they  are  forced  to  give  more 
than  this,  by  undue  strain  in  taking  the  bite, 
represents  the  amount  the  teeth  will  have  to  be 
shortened. 

And  since  most  dentists  (nearly  all)  take 
such  impressions,  abnormally  straining  for  such 
tissues,  just  so  many  have  to  after-grind;  or 
else  compel  their  patients  to  go  through  an  un- 
necessary, long  season  of  annoying  and  painful 
adjustment. 

And,  of  course,  just  the  same  results  follow 
undue  pressure  in  trying  the  teeth,  set  up  on 
tlie  base^plate,  in  the  mouth.  "Just  wear  'em 
till  you  get  used  to  'em," 

But  it  is  reversely  true  that,  in  such  cases 
of  soft  tissues,  insufficient  strain  on  the  bite 
gives  lack  of  proper  up-touch  of  the  teeth.  So 
it  sometimes  ha])])ens  tliat,  in  cases  of  too  light 
pressure  in  tlie  bite,  tlie  artificial  teeth  are  cor- 
respondingly too  short. 

While  we  can  get  the  ])ressure  almost  ex- 
actly right,  with  little  trouble,  by  the  use  of  the 
pi-essometer  test^slips  in  clear  mouths,  we  can 
get  it  practically  so  without  them  in  ])artial 
cases  by  my  recent  compensating  discovery. 


210  Greene  Brothebs'  Clinical  Course 

And  this  is  the  way  1  do  it:  I  first  make  my 
bite=plate,  preferably  of  Kerr  perfection  base= 
plate  material,  to  tit  snugly  onto  my  model. 
Then  stiffen  it  with  annealed  brass  wire.  The 
soft  wire  is  first  bent  to  the  bare  model  and 
then  warmed  and  pressed  into  the  now^placed 
base^plate. 

Though  this  wire  is  pliable,  it  is  stiff  enough 
to  make  the  base  -  plate  rigid,  so  it  can  he 
removed,  off  and  on,  in  the  preparation  and  oper- 
ation. 

On  this  Kerr  base  I  place  modeling  com- 
pound to  reach  up  to  the  opposing  teeth,  natural 
or  artificial,  above,  and  to  press  them  a  little; 
then  trim  off  the  sides  of  this  bite^rim  to  rid  of 
surplus. 

Then  for  the  bite.  The  compound,  alone,  is 
warmed  and  the  jaws  closed  on  it  till  the  front 
teeth  come  properly  together.  Their  coming- 
together  is  our  guide=stop. 

xYotc,  if  the  bite-rim  is  softer  than  the  flesh 
under  it,  the  pressure  will  not  be  too  strong. 
But  the  chances  are  five=to=one  that  the  material 
will  be  too  hard  at  the  actual  biting  instant. 

As  I  rather  expect  this,  I  forestall  it  with 
a  very  thin,  soft  plaster  addition  on  top  of  the 
compound,  after  first  shaving  off  a  little  of  the 
latter,  to  make  room  for  the  plaster.  The  slow 
setting  of  the  creamy  plaster  gives  ample  time 
for  the  operation.  And  tlie  softness  of  it  always 
provides  against  overstrain. 

But  in  very  soft  cases,  where  the  gums  are 
sure  to  settle  a  good  deal  from  pressure  by  wear- 
ing a  plate,  provision  must  be  made  for  the 
change.  That  is,  the  artificial  teeth,  when  fin- 
ished, should  touch  their  opponents  a  little  before 
the  front  natural  ones  touch  theirs;  the  amount 


IX   Dextal   Prosthesis.  211 

of  the  CiVtra  strain  being"  according  to  the  softness 
of  the  tissues. 

1  arrange  for  this  fore-touching  of  the  arti- 
ficial teeth  by  placing  a  sheet,  or  several  sheets, 
of  tinsfoil  on  the  ends  of  the  front  lower  natural 
teeth,  closely  adapted,  ichile  the  bite  is  taken; 
and  then  place  it  onto  the  model  when  the  arti- 
ficial teeth  are  being  set  up. 

The  thickness  of  this  provisionary  foibstrip 
depends  on  the  yieldance  of  the  gums  to  be  bitten 
on.  It  gives  to  the  rear  artificial  teeth  an  extra 
length  just  a  small  per  cent  less  than  the  thick- 
ness of  the  foil.  The  grain  of  guess=work  about 
the  foil  provision  is  made  admissible  by  the 
accommodating  adaptability  of  soft  tissue.  Any- 
how, it  is  practicable  enough  to  bridge  over  a 
deep  chasm  of  trouble.  (This  simple,  new  solu- 
tion of  a  vexing  old  problem  is  carefully  shown 
in  our  verbal  Course.) 

X.  B. — I  should  have  stated  timely  that  I  re- 
move at  least  a  part  of  tlie  modeling'compound* 
and=plaster=bite  from  the  base-plate  foundation, 
after  the  case  is  in  the  articulator;  and  then  put 
enough  sticky=wax  on  to  set  the  teeth  into.  The 
base-plate  itself  isn't  removed  until  tlie  flask  is 
opened  for  packing. 

It  may  not  be  amiss  here  to  re-mention  that 
in  these  partial  cases  the  lateral  movement  of 
the  jaw  should  be  attended  to,  either  on  tlie  bite- 
rim  in  the  mouth  or  on  the  articulator.  The 
latter  is  preferred  when  tlie  bite  on  the  modeling 
compound  is  finished  out  with  the  cream=like 
plaster.  Sometimes  both  are  advisable.  In  fact, 
such  cases  indicate  our  scheme:  Kach  mouth  its 
ozcu  articulator  in  the  iiui.sJi — which  1  will  now 
soon  show  you  in  gratitudinal  detail;  and  extrem- 
est  satisfaction.  I  hope. 


212  Greene  Brothers'  Clinical  Course 

You  are  all  familiar  with  the  use  of  tlie  car- 
bon and  wax  strip  in  after^grindint*-  for  occlu- 
sion. Well,  I  've  given  you  a  much  preferable 
way,  by  which  all  such  grinding  is  done  unknown 
to  tlie  patient,  and  with  utmost  accuracy;  that 
is,  by  taking  a  short=bite,  re^articulating  the  fin- 
ished plates,  and  doing  all  grinding  in  the  lab- 
oratory, out  of  sight. 

But,  if  only  a  little  touching'up  is  needed, 
you  can  indicate  with  the  Kerr  tracing'Sticks. 
Dry  the  teeth,  trace=on  a  thin  laifcr,  warm  it 
well,  and  have  patient  bite  into  it.  Then  remove 
the  particular  thin  flake  where  it  is  bitten 
through,  and  grind  ^vith  small  carborundum 
bulb.  Then  trace=on  more  and  repeat,  biting  and 
grinding,  till  you  get  a  close^touching  occlusion 
everywhere. 


IX  Dextal  Prosthesis.  213 


THE  NEW  COMMON  SENSE  OCCLUSION. 


EVERY  MOUTH  ITS  OWN  ARTICULATOR. 

Since  the  publication  of  this  Printed  Course 
in  1910,  I  have  made  the  most  valuable  discovery 
in  occlusion  ever  mentioned,  and  the  most  prac- 
tical invention  for  carrvino-  it  out  after  secured. 
And,  of  course,  this  introduction  will  make  obso- 
lete some  of  the  ways  and  means  that  were  ad- 
vanced thoughts  a  few  years  ago;  in  fact,  so///£' 
I   ve  just  given  you. 

I  here  refer  especially  to  the  scientific  methods 
of  grinding  teeth  after  tlie  plate  is  vulcanized, 
to  secure  technical  occlusion. 

We  have  no  use  for  these  grinding  methods 
any  more,  for  we  have  a  method  for  securing 
final  occlusion  ( "every  mouth  its  own  articulator 
in  the  finis"),  with  anatomic  perfection,  proving 
it  by  actual  test,  and  then  holding  it  until  the 
work  is  finished. 

For  explanation  and  illustration: — ^^Doctors: 
— how  often  it  happens  that  when  you  have  the 
most  perfect  occlusion  of  teeth  in  dentures  hcfore 
packing,  you  find  you  have  to  grind  to  correct 
it  after  vulcanizing.  Kvery  plate  maker  often 
has  this  "luck." 

Faulty  occlusion  may  result  from  several  dif- 
ferent causes;  as  incorrect  bites  and  wrong  and 
conflicting  pressures  in  impressions  and  bites.  If 
you  took  an  impression  (in  some  mouths)  at  one 
strain  and  your  bite  at  a  different  strain  your 
case  would  not  occlude  in  the  mouth,  when  '^'try- 
ing  your  teeth  in."  And  so  would  an  uneven 
closing  of  your  fiask  give  a  similar  result.  All 
this  you  know  by  experience. 


214  Greene  Brothers'  Clinical  Course 

For  example:  after  you  set  your  teeth  up  ou 
your  base*plates  in  your  articulator  you  take 
your  case  off  the  model  and  try  it  in  the  mouth. 
Now,  why  ?  To  "see''  whether  it  is  right  when  in 
the  mouth.  That  is  to  say,  you  can't  trust  your 
bite,  or  your  articulator,  and  now  wish  to  verify 
by  actual  test. 

Well,  when  your  test  is  satisfactory,  are  you 
dead  sure  you  get  it  back  onto  the  model  exactly 
as  it  was  before  ^  Possibly  you  strained  it  a  little 
in  replacement,  if  nothing  else.  If  not,  well  and 
good. 

Biit^  what  if  you  find,  in  another  case,  that 
it  does  not  occlude  rightly  in  the  mouth?  Then, 
why  not?  Because  you  are  trying  it  in  at  a 
different  strain  on  the  tissues  from  what  the 
strain  was  when  you  took  your  impression,  or 
when  you  took  your  bite.  A  conflict  of  stress 
throws  you  off.     (How  few  ever  think  of  this!) 

When  5^ou  correct  it  in  the  mouth  (of  course 
by  the  anatomical  movements  of  the  jaw),  now, 
how  are  j^ou  to  maintain  this  correction  when 
you  put  it  back  onto  the  model  for  investment 
in  the  flask?    Do  you  see  your  trouble? 

AVell,  now  let  us  take  our  bite,  verify  our 
occlusion  and  take  our  impression  all  at  the  same 
strain,  and  avoid  conflict  of  stresses.  It  will  take 
a  little  bit  more  work  and  little  time,  but  we  '11 
save  more  in  the  long  run.  We  '11  wind  up  with 
just  the  occlusion  we  want  and  avoid  all  grind- 
ing after  vulcanizing. 

We  will  take  our  case  off  the  model,  from 
the  articulator,  correct  it  in  the  mouth  anatomi- 
cally ("every  mouth  its  own  articulator  in  the 
finis")  and  take  a  final  plaster  impression  in  the 
adjusted  and  occluded  case  itself;  and  produce  a 
model  in  place  and  never  take  the  case  off  of  it 
until  after  vulcanizing. 


IN   Dental   Prosthesis.  215 

The  work  is  thus:  Adjust  the  set=up  and 
waxed'up  teeth  to  anatomical  occlusion  by  real 
anatomical  movements  of  the  jaws  themselves. 
I'irst  as  to  the  up-and-down  motion,  and  then  as 
to  the  little  natural  lateral  motion  of  the  jaw  that 
is  used  in  chewing.  (Don't  over=do  this  stunt  by 
exaggerated  "lines,"  "])lanes"  and  "paths"  for 
show  purposes. ) 

Your  stiff,  hard  base=plate  sticks  fast  in  the 
nioutli  and  you  can  thus  occlude  to  teeth  with 
ease  and  perfection.  (If  necessary,  use  gum 
tragacanth  to  stick  it.)  Xow,  let  the  ])atient 
spit  the  case  out  of  her  mouth  carefully,  for  the 
sticky  wax  may  be  a  little  soft  around  the  teeth. 
Use  a  mouth  blowpipe  and  melt  the  wax  fast  to 
the  pins  in  the  teeth  and  cool  the  whole  thing. 

Xow,  fill  it  with  tliin  j)laster;  pour  out  all  the 
l)]aster  you  can;  replace  a  wee^bit  in  the  center 
(all  impressions  must  scatter  from  the  center) 
and  take  her  impression,  letting  patient  bite  down 
lightly,  and  hold  it  firmly  till  the  remnant  in  the 
little  jjorcelain  imjn-ession  bowl  is  hard;  then  have 
her  spit  it  out  again.  Xow,  Doctors,  doift  here 
forget  to  scarify  the  l)ase*plate  a  little  and  wet 
her  mouth  with  olive  oil  just  before  taking  the 
im])ressi()n.  Olive  oil  and  glycerine  together 
will  ])revcnt  adhesion  to  the  tissues. 

Xow.  take  the  impi-ession  out  carefully,  and 
after  it  is  dry  brush  on  your  separating  fluid  as 
usual.  Xow  "pour"  and  make  your  model  (much 
])referably  using  the  (ireene  Approximate  metal 
models).  Then,  when  your  model  is  made  leave 
it  in  the  impression  and  go  on  and  invest  as  usual. 
But,  Doctors,  listen  to  me:  I  am  now  "oiup'  to 
tell  you  something  of  importance;  but  will  first 
ask  you  a  question:  How  often,  when  you  have 
the  most  satisfactory  occlusion  ///  flic  mouth,  you 


216 


Greene   Brothers'  Clinical  Course 


have  to  do  more  or  less  grinding  of  teeth  in  cor- 
recting occhision  after  vulcanizing. 

Every  plate  maker  has  this  experience  be- 
cause it  belongs  to  and  is  a  part  of  the  old,  vm- 
certain  way  of  doing  plate  work. 

Well,  if  you  had  perfect  occlusion  before 
flasking  and  now  it  is  "off"  what  has  happened^ 
AVhy,  in  bringing  the  sections  of  your  flask  to- 
gether, after  packing,  the  plaster  yielded,  gave 
Avay  by  compression,  and  the  teeth  became  mis- 
placed. They  were  either  pushed  outward  or 
pushed  down  into  the  disintegrated,  soft  plaster: 
or,  maybe  both.  And  you  vulcanize  your  plate 
with  teeth  in  misplaced  condition.  You  brought 
the  front  part  together  first  (as  often  must  be 
done)  and  in  bringing  the  heels  together  you 
used  more  force;  so  your  jaw  teeth  were  pushed 
down  into  the  plaster  the  most.  The  result  is 
that  your  once  good  occlusion  now  strikes  first 
at  the  heels  in  the  mouth  after  vulcanizing. 

Xow,  I  have  invented  and  constructed  a  very 
simjjle,  convenient  and  cheap  method  and  an 
appliance  for  holding  teeth  in  place,  ahsolufeUj, 
so  that  you  have  the  ])recise  occlusion  after  vul- 
canizing that  you  liad  before.  This  new  inven- 
tion we  call  Greene's  OecJusion  Retainer. 


IX   Dextal   Prosthesis.  217 

GREENE'S   OCCLUSION  RETAINER. 

This  is  a  metallic  re-inforcing  appliance  to 
strengthen  2)laster,  or  other  investment,  and  pre- 
vent the  yielding  and  displacement  of  the  teeth 
under  flask  pressure,  during  the  processes  of 
Masking  and  vulcanizing.  It  is  a  metallic  plate 
of  copper  sheeting,  constructed  semi=circle  with 
a  perpendicular  wall  and  horizontal  floor.  It  is 
made  adjustahle,  to  be  fitted  over  the  ends  of 
the  circle  of  the  set-up  and  waxednip  teeth  be- 
fore douhle=flasking. 

Thus,  after  you  have  your  case  occluded 
("tried"'  and  corrected  in  the  mouth)  and  set  into 
the  flrst  half  of  the  flask  and  are  ready  to  double^ 
flask,  adjust  the  retainer  over  the  arc  so  that  each 
tooth  may  sit  against  the  floor-angle,  or  nearly  so. 

This  adjustment  is  done  by  springing  and 
bending  the  horse=shoe'shaped  appliance  with 
fingers  or  pliers.  When  it  is  adjusted  onto  the 
arc  of  the  teeth  take  it  ofl'  and  fill  it  with  plaster 
(jolting  out  all  air  bubbles)  and  slip  it  back  onto 
the  ends  of  teeth,  plastered  fast. 

Well,  now  go  on  and  double=flask  as  usual. 
When  you  open  the  flask  you  find  the  ends  of 
the  teeth  setting  down  onto  the  floor  and  u]) 
against  the  side  of  the  metalhc  rehiforcer  and 
held  there  irresistibly.  No  matter  how  much 
strain  you  exert  in  flasking,  yoiu-  teeth  can't  yield 
in  the  investment.  Xow,  if  you  had  correct 
occlusion  before,  you  still  have  it  after  vulcaniz- 
ing. With  the  proper  use  of  Greene's  Occlusion 
Retainer  you  never  need  to  grind  even  a  cusp 
after  vulcanizing,  if  correct  before. 

And,  Doctors,  you  often  have  your  plate  to 
come  out  much  thicker  than  your  base=plate. 
This  may  be  caused  by  the  compressing  of  the 
arch  of  your  ])laster  investment,  under  heat 
moisture  and  ])ressure.     To  reinforce  this  T  have 


218  Greene  Brothers'  Clinical  Course 

invented  a  metallic  arch  to  be  placed  onto  the 
palatal  part  of  the  base=plate  before  double* 
flasking.  By  the  use  of  this  little  device  plates 
come  out  the  same  thickness  of  the  base  plates; 
so  no  scraping  is  needed;  none  allowed  in 
Greene's  system.  Scraping  on  one  side  of  a  vul- 
canite plate,  and  not  the  other,  causes  weakness 
and  liability  to  warp  and  break. 

FULL  DOUBLE  SET. 

In  case  of  full  sets  (two  dentures)  you  go 
on  and  do  just  as  I  have  told  you  up  to  the  point 
of  taking  the  plaster  impression  ("pass=word 
method") .  In  case  of  double  sets  3'ou  needn't  use 
the  plaster  in  the  upper  set.  We  don't  use  the 
plaster  to  improve  the  fit  of  the  plate,  but  to 
maintain  the  occlusion. 

When  you  make  both  plates  just  go  on  and 
vulcanize  the  upper  (jn  the  original  model,  after 
verifying  occlusion  in  the  mouth.  When  finished 
then  re-test  the  lower  to  it.  Then  take  plaster 
impression  in  the  lower,  biting  it  up  against  the 
finished  upper  set,  just  as  I  have  described  the 
taking  of  it  for  a  lone  upper  case. 

I  will  repeat:  the  taking  of  the  plaster  im- 
pression in  the  case  is  not  to  improve  the  fit  of 
the  plate  to  the  mouth ;  that  has  been  guaranteed 
b}'  your  first  advance  "test"  impression.  But  it 
is  to  secure  occlusion  at  proper  strain,  and  main- 
tain it  against  change,  to  the  finish.  However, 
if  you  finish  the  two  plates  together  then  better 
use  the  plaster  in  both  sets,  as  described.  But  it  's 
best  to  occlude  the  lower  teeth  in  wax  to  those  in 
the  vulcanized  plate  above. 

The  plaster  in  the  lower  case  will  furnish  a 
model  in  its  exact,  right  relation;  and  the  Occlu- 
sion Retainer  will  hold  every  tooth  into  its  place 
in  its  investment  while  packing  and  vulcanizng. 


IN  Dental  Prosthesis.  219 

COMMON  SENSE  OCCLUSION  SHOWN  IN  MOUTH. 

Class  asks  that  I  review  this  and  show  it  in 
my  own  mouth.  1  'm  glad  to  do  it;  as  it  's  my 
last  "discovery"  and  best  stunt  in  the  'whole  bite 
and  occlusion  business. 

Well,  I  '11  begin  anew  and  take,  for  instance, 
a  "test"  modeling  compound  impression  (Kerr- 
Perfection)  as  shown  in  our  first  lecture  lesson. 
(Could  take  it  in  plaster  by  the  pass-word  meth- 
od, but  no  need  of  it.) 

But,  now,  1  11  first  take  a  modeling  com- 
pound impression  of  my  lower  natural  teeth  and 
pour  a  model,  to  l)e  hardening  while  I  take  my 
upper  impression. 

Xext  I  '11  take  my  upper  and  make  a  plaster 
model  on  it.  And  on  tliis  plaster  model  I  '11  make 
me  a  Kerr  Perfection  base=plate,  as  I  've  already 
described.     ^lake  it  fit. 

Xow  I  '11  take  my  close=range  no*bite  as  you 
have  already  been  shown.  And  to  hurry  up 
matters  I  '11  take  my  no^bite  in  Greene  sticky 
wax,  well  fastened  onto  my  basc'plate.  And  I  '11 
not  forget  to  strengthen  my  base^plate  across  at 
its  rear  with  a  little  wire  heated  onto  it. 

I  '11  now  articulate  my  case  here  in  my  ana- 
tomically im])roved  Old'Line  "approximator." 
It  has  all  the  movement  I  need,  since  its  regener- 
ation. This  A\ill  give  me  as  close  occlusion  as 
ever  secured  in  any  old  way. 

But,  see  here,  doctors,  I  may  have,  in  my 
semi^soft  mouth,  taken  my  impression  and  my 
bite'])ressure  and  my  mouth-itself  occlusion  at 
varying  stresses.  I  '11  do  away  with  all  con- 
flicting strain  and  take  'em  all  at  the  same  exact 
strain,  all  at  one  time,  in  a  new  plaster  impression. 

I  '11  take  the  case  off  of  the  model,  in  the  ar- 
ticulator; put  it  into  my  mouth  and  anatomically 


220  Greene  Brothers'  Clinical  Course 

readjust  the  upper  teeth  to  my  lower  natural 
ones. 

While  the  case,  waxed^u]),  will,  as  a  whole  be 
cool  and  rigid,  the  teeth  thereon,  themselves,  will 
be  slightly  warmer  so  as  to  give  a  little  in  their 
wax  environment. 

I  '11  slip  the  case  into  my  mouth  and  bring 
my  jaws  together  by  a  no*bite.  I  '11  finger*pull 
the  teetli  down  onto  my  natural  lower  ones  all 
round  till  they  all  touch  the  way  I  want  them, 
while  at  the  same  time  I  '11  bite  up  lightly. 

Xow  all  are  together,  perpendicularly.  I  '11 
hold  them  so  and  "side=wiggle"  and  sheep=chew 
( lateral  motion ) ,  a  little. 

Xext  I  '11  spit  the  case  out  of  my  mouth  and 
most  carefully  mouthsblow=pipe  tlie  sticky  wax 
to  the  pins  of  the  teeth.  This  is  natural  anatom- 
ical occlusion. 

Xext  I  '11  cool  it  all  and  scarify  the  roof  of 
my  base*plate  a  little.  And  I  '11  olive=oil  my 
mouth  a  little;  and  take  a  thin  plaster  impression 
(pass-word  way),  in  my  adjusted  case. 

I  '11  wait  till  the  remnant  plaster  in  my  little 
earthen  bowl  is  hard;  and  then  spit  it  out  again. 
I  '11  be  careful  not  to  touch  the  waxed  teeth,  for 
fear  I  might  displace  them. 

Xow,  after  my  plaster  impression  is  dry,  I  '11 
varnish  with  separating  fluid;  then  soap*stones 
dust  it  with  soft  brush  and  therein  make  my  final 
model;  of  course,  this  time  preferably  using  the 
Greene  ready-made  approximate. 

Xow,  doctors,  you  see  I  've  taken  my  impres- 
sion in  my  bite  and  my  occlusion  pressures  at  all 
same  stress;  all  at  once.  So  there  can  be  no  con- 
flict in  them. 

Xow  I  '11  set  my  case  in  the  first  half  of  the 
flask,  seeing  there  is  but  little,  if  any,  plaster 
under  it,  to  disintegrate  and  change.     And  here 


IN  Dental  Prosthesis.  221 

I  '11  adjust  Greene's  Occlusion  Retainer  over  the 
ends  of  the  teetli  and  plaster  it  on  iclthout 
hluhhers;  and  go  on  and  finish  double=flasking, 
as  usual.  And  I  '11  go  on  and  pack,  and  vulcan- 
ize at  lowest  temperature  and  cool  off  slowly. 

The  metal  model  will  prevent  any  change  in 
my  plate.  The  Occlusion  Retainer  will  prevent 
any  displacement  and  change  in  the  teeth  in  their 
embedment. 

And  by  vulcanizing  at  low  temperature  and 
cooling  off  slowly,  I  '11  not  have  to  grindstouch 
even  a  cusp  after  vulcanizing;  not  once  in  a  hun- 
dred times.  Xor  in  fact  did  I  grhid  any  in  occlud- 
ing. I  have  the  smooth,  sharp,  definite  cusps  as 
made  and  l)urned  onto  my  grinders.  And  I  need 
them  since  my  lower  teeth  are  flatly  abraded 
down  from  75  years  grateful  servitude. 

Well,  now,  doctors,  if  I'  ve  used  the  Greene= 
Roof  Re=enforcer  to  ])revent  my  vulcanite  plate 
from  coming  out  thicker  than  my  base-plate 
(Kerr's  is  the  ])roper  thickness)  I  '11  have  no 
aftersscra])ing  to  do. 

Xo  filing,  no  grinding,  no  scraping  by  the 
Greene  system  of  platenvork. 


CORRESPONDENCE  SOLICITED 

FOR 

GREENE  BROTHERS'  VERBAL  COURSE 

TO 

STATE  MEETINGS, 
DISTRICT  MEETINGS. 
STUDY  CLUBS, 
COLLEGES  and 
CLASSES 

Address: 

DR.  J.  W.  GREENE 

Chillicothe,  Mo. 


KERR  PERFECTION  IMPRESSION  COMPOUND 


Test  impression  taken  by  Dr.  J.  W.  Greene  of  his 
own  mouth  in  Kerr  Perfection  Impression  Compound, 
showing  complete  muscle  trimming. 

A  plate  from  it  would  be  a  minute  duplicate  without 
any  further  trimming. 


KERR  PERFECTION  IMPRESSION  COMPOUND 


Softens  Easily — Hardens  Quickly 

It  is  Impossible  to  Make  Good  Work  With  a  Poor 
Impression. 

Kerr  Perfection  Lmpression  Comtouxd  takes  a 
clean  cut,  sharp  impression,  showing  e\ery  detail 
with  accuracy.  Softens  at  a  low  temperature.  It 
hardens  quickly  and  evenly  in  the  mouth,  becoming 
very  hard,  and  does  not  warp  or  creep.  A  perfectly 
fitting  plate  can  be  made  from  a  Perfection  Impres- 
sion where  other  means  have  failed. 

(Dr.  J.  ^^^  Greene  has  used  this  material  exclusively 
in  all  his  clinic  impression-work). 

PRICE,  per  box,  38  CENTS 


Manufactured  by  the 


Detroit  Dental  Manufacturing  Company 

DETROIT,  MICH.,   U.  S.  A. 


Kerr  Perfection 


Compound  Sticks 


.  Are  very   convenient  when   it   is  necessary  to   add   a  small 
quantity  of  material  to  an  impression. 

The  end  of  a  stick  can  be  softened  or  meUcd  over  a  Hame 
and  quickly  and  accurately  traced  on  where  wanted. 
(Suggested  hy   Dr.  J.   W.   Greene.) 
PRICE,  per  box.  38  CENTS 
Manufactured  by  the 

Detroit  Dental  Manufacturing^  Company 

Detroit,  Mich.,  U.  S.  A. 

Kerr  Perfection  Impression  Compound  Wafers 


Are  thin  sheets  almiM    nc    i     .  .i;.    ~   ..f  light  cardboard. 
Can  be  softened  quickly   over   a   llanie   and    spread   over   a 
surface  to  add  slightly  to  its  thickness. 

Will  be  found  very  convenient   for  a  temporary  refit  of  the 
roof  and  ridge  of  a  plate. 

(Suggested  by  Dr.  J.  W.  Greene,  for  various  uses.) 

PRICE,  per  box.  38  CENTS 

Manufactured  by   the 

Detroit  Dental  Manufacturing  Company 

Detroit,  Mich.,  U.  S.  A. 


KERR  PERFECTION  BASE  PLATES 

For  Trial  Plates. 


A  thin,  rigid  base  plate  that  will  not  soften  or  bend  with  the 
heat  of  the  mouth,  making  it  invaluable  in  prosthetic  operations. 

In  vulcanite  work  one  base  plate  will  last  for  all  the  neces- 
sary operations,  such  as  taking  the  bite,  setting  up  the  teeth, 
trying  in,  etc.,  etc. 

Directions. 

AhhdUgb  (lr\  heat  may  lie  used  to  .soften  for  adaptation  to 
the  model,  the  best  results  arc  obtained  by  placing  both  tlie  cast 
and  the  base  plate  in  water  as  hot  as  the  hand  will  bear  and 
gradually  working  down  to  the  model.  Then  trim  excess,  glaze 
sharp  edges  over  a  burner  and  cool. 

Price,  per  box $  .40 

Manufactured  b\- 

Detroit  Dental  Manufacturing  Company 

Detroit,  Mich.,  U.  S.  A. 

Greene  Sticky  Wax 

Especially  prepared  and  put  up  in  convenient  form  for  plate 
work,  where  a  good  strong  sticky  wax  is  needed  for  waxing  the 
teeth  to  the  base  plate. 

PRICE,  per  box,  40  CENTS 

Manufactured  by  the 

Detroit  Dental  Manufacturing  Co* 

Detroit,  Mich.,  U.  S.  A. 


Greene-Kerr  Impression  and  Bite  Trays  with 
Removable  Handles 

As  Used  in  Dr.  Greene's  Test  Method  of  Taking  Impressions 

PATENTED    MARCH    14,1911 


Nos.   1,   2,   3,  4,   Upper 


Nos.    1,   2,   3,   4,   Lower 


Xos.  5,  6,  Lower  I'artials 


These  trays  are  made  of  a  thin  flexible  metal  with  lower 
rim,  shorter  in  length  and  shallower  than  the  finished  plate 
is  to  be  so  that  the  metal  does  not  strain  on  the  lip  and  cheek 
tissues  or  back  palate. 

They  are  so  shaped  that  they  require  a  minimum  amount  of 
change. 

The  handle  can  be  quickly  removed  for  muscle-trimming  and 
to  show  how  impression  fills  out  the  lip  and  cheeks ; — reinsert 
handle  for  removal. 

'i'lie  trays  are  specially  designed  for  taking  impressions  with 
Kerr   Perfection  Impression  Conii)ound  l)y  the  Greene  System. 
PRICE.  each     $  .30 

PRICE,  full  set  of  ten     $3.00 

Manufactured  by  the 

Detroit  Dental  Manufacturing  Company 

Detroit,  Mich.,  U.   S.  A. 


THE  GREENE  READY-MADE,  NON-CHANGEABLE 

APPROXIMATE   MODELS 
For  Vulcaniteand  Celluloid  Work,  and  Swaging. 

Invented    by   Dr.  J.   W.   Greene. 

Patented  June  13,   1908. 


Doctor:  Doesn't  it  frequentlj',  if  not  often,  happen  that  with 
even  a  "good  impression  you  have  a  badly  fitting  "denture"  ? 

Do  you  know  how  this  mostly  happens?  You'll  probably 
answer :  "My  impression  changed  before  I  poured  my  model,  or, 
maybe,   my  model   changed  before   I   used   it." 

These  things  may  have  occurred,  but  nine  chances  to  one 
they  did  not.  Your  trouble  far  more  probably  came  from  change 
that  took  place  in  your  plaster  model  in  Hasking  and  vulcanizing; 
or  in  squeezing,  if  a  celluloid  case. 

Why,  even  the  very  best  of  plaster  models  are  liable  to 
change  shape  under  heat,  moisture,  and  pressure.  And  faulty  ones 
are  sure  to  do  it. 

In  fact,  most  plaster  disintegrates  at  about  300°  F.  So  you 
nearly  always  vulcanize  on  a  soft-surfaced  model,  and  often  on 
one  really  mushy  throughout. 

In  such  cases  you  depend  on  environment  to  hold  your  mu.sh 
in  shape.  But  if  your  pressure  in  flasking  is  heavy,  or  undue  in 
any  direction,  your  soft  plaster  model  will  yield,  and  your  plate 
will  differ  in  shape  from  your  impression  of  the  mouth. 

The  remedy  is 
THE     GREENE     READY-MADE     NON-CHANGEABLE 
MODEL  SYSTEM. 

These  models  are  made  of  cast  Aluminum,  100  different 
shapes  in  a  set — 87  uppers  and  13  lowers. 

The  uppers  are  of  seven  different  sizes,  numbered  from  14  to 
20,  these  sizes  grading  one-eighth  of  an  inch  in  difference  in 
width.  Then  in  each  sice  there  is  an  average  of  a  dozen  dift'erent 
shapes  to  conform  to  as  many  different  styles  of  mouths  and 
gums — as  deep,  shallow,  thick,  thin,  broad,  narrow,  etc.  These 
shapes  are  lettered. 

With  these  100  full  patterns  any  normal  case  can  be  accom- 
modated. 

The  models  cannot  break,  bend,  wear  out,  nor  get  out  of 
order;  but  may  be  used  over  and  again  indefinitely. 

The  full  set  is  put  up  in  a  neat  case,  with  a  special  compart- 
ment for  each  shape,  numlicred  and  lettered. 


HOW  TO  SELECT,  FIT  AND  USE  THEM. 

Take  your  impression  as  usual;  or  better,  by  the  Greene 
method,  using  Kerr  Perfection  Impression  (which  gives  you  the 
exact  Iieight  of  rim  and  length  of  intended  plate,  and  an  abso- 
lute advance  test  as  to  its  fitting).  Now  measure  across  the  back 
of  your  impression,  from  outside  to  outside  of  tul)erosities,  to 
get  its  she  and  immber.  For  instance:  two  inclies  wide  would  be 
the  width  of  No.  16. 

Select  from  model  No.  15,  which  is  one-eighth  of  an  inch 
narrower  than  No.  16,  the  nearest  the  shape  of  the  impression. 

This  selected  model  should  slip  loosely  down  into  the  im- 
pression. If  it  lacks  a  little  of  go:ng  in,  use  Carbon  paper  to 
indicate  and  find  the  places,  and  file  or  scrape  the  model  off  to 
let  it  in  with,  say.  an  eighth  of  an  inch  play;  less  will  do. 

After  your  model  will  drop  into  the  impression  readily,  it  is 
fitted.  Then  mix  your  plaster  (good  plaster),  smear  your  model 
all  over  its  face-surface  carefully;  then  pour  a  little  plaster  into 
the  impression,  fullest  in  the  center,  and  push  the  besmeared 
model  down  into  it,  and  go  on  and  finish  as  if  model  were  all 
plaster. 

You  now  liave  a  model  aI)out  90  per  cent  metal,  in  bulk, 
with  10  per  cent  or  less  of  i)laster  veneering  over  its  face.  The 
metal  will  not  change  at  all,  while  the  very  thin  coating  of  plas- 
ter facing  (being  supported  by  metal)  cannot  change  perceptibly. 

Nor  does  it  take  much  longer  to  make  this  non-changeable 
cast  than  the  old.  faulty,  all-plaster  sort.  Go  on  and  use  it  the 
same  as  if  all  plaster,  in  vulcanite  or  celluloid  work. 

In  using  these  ai)proximate  models  for  partial  cases,  first  fill 
the  tooth  sockets  in  the  impression.  If  in  removing  the  impres- 
sion from  the  model  you  should  break  off  a  tooth,  just  cement  it 
back  to  its  place  with  thin  cement,  which  makes  it  stronger  than 
before  broken. 

TO   SEPARATE   IMPRESSION   FROM   MODEL. 

Remove  the  impression  from  the  model,  rather  than  model 
from  impression.  First  remove  the  metal  tray  from  impression, 
by  warming  the  metal  over  spirit  flame.  If  impression  is  model- 
ing compound  (Perfection  Impression  Material),  or  wax,  first 
warm  the  impression  gently  in  shallow  water,  leaving  the  model 
as  cool  as  possible,  and  peel  the  former  off  from  the  latter. 
FOR  SWAGING. 

To  complete  them  for  swaging,  use  a  half-and-half  mixture 
of  Portland  cement  and  plaster,  well  ground  together  in  a  mor- 
tar, before  wetting. 

And  to  swage  on  them  w-hen  the  new  process  methods  of 
pressure  are  used,  first  "cow-horn"  your  blank  plate  over  a 
metal  model  of  the  next  size  larger  than  the  one  you  are  going 
to  finally  swage  to. 

If  you  u.se  the  Greene  method  of  taking  impressions,  you 
can  swage  turn  the  very  utmost  rim  edge  of  your  plate,  to  fit  the 
muscles  to  such  exactness  as  to  need  no  trimming  after  plate  is 
wi>rn,  unless  the  mouth   changes. 

Price,   Full    Set    of   100  Models,   $20.00 
Price,   Selected  Set  of  24  Models,     6.00 

Manufactured   by 

DETROIT     DENTAL    MANUFACTURING     CO., 

DETROIT,   MICH.,    U.   S.   A. 


GREENE  S  OCCLUSION  RETAINERS 


t*-£.s-£0  NOV.   4     1613 


A  flexible  xnetaJlic  semi-circle,  re-inforcing  appliance 
with  perpendicular  wall  and  borizontal  floor. 

To  be  fitted  o\er  the  endi  of  the  set  up  and  waxed 

up  teeth  l^rfore  double  flashing  to  strengthen  plaster  or 

r   investment,    and   pre\-ent  the   yielding  and   dis- 

-,    . .     .-  ♦. ,  .  ..-.  ...  ^^_   ^"-c^  pressure  during  the 

•^• 

Most  valuable  in  Gum -Section  Cases. 

After  ycm  have  case  set  into  first  half  of  flask  and 
ready  to  double  flask   adjust  the  retainer  o\-er  the  arch 
'  *""ateach  tooth  may  set   against  the  floor  angle    or 
.-.'  so. 

When  adjusted  to  fit  arch  of  teeth,  fill  it  with  plaster, 
jolt  otit  air  bubbles  and  slip  it  onto   them    and   finish 

fla&king  as  usual . 

Price  Set  of  T^ree. 7ftc. 


■  afiulactpffcC  i>j  tne 


Detroit  Dental  Manufacturing  Company 

Detroit,  Mich.,  U.  S.  A. 


/^ 


COLUMBIA  UNIVERSITY  LIBRARIES  (hsi.stxi 

RK  656  G83  1914  C.I 

Greene  brothers  clinical 


2002126281 


J 


